bluuebunny/crossref_metadata_2025_split huggingface dataset:
Disparities in length of goals of care conversations between oncologists and patients with advanced cancer.
Authors: Smith Cardinale B. , Pintova Sofya , Adelson Kerin B. , Gonsky Jason Parker , Egorova Natalia , Bickell Nina A. 
Published: November 2018

19 Background: Studies show minority patients have inadequate discussions about treatment, prognosis, and goals of care (GoC) which translate into substandard treatment, worse quality of life, and poorer survival than whites. However, there is a paucity of data on the quality of communication among minority patients with advanced cancer. We studied factors impacting the oncologists’ time spent during GoC discussion visits with their minority and non-minority patients. Methods: At community, academic, municipal, and rural hospitals, we recruited and randomized solid tumor oncologists and their newly diagnosed advanced cancer patients with <2-year prognosis to participate in a RCT, testing a coaching model of communication skills training. Patients were surveyed after post-imaging visits. These visits were audiotaped and median encounter time recorded. We define GoC discussions as patients report that their doctor talked about preferences for cancer treatment and clarified things most important to them given their illness. Comparisons were made using non-parametric tests. We used mix-effect models for risk adjustment. Results: For 22 randomized oncologists in the study,142 post-imaging encounters were audiotaped. Of these, 38% were non-Hispanic White, 32% non-Hispanic Black and 19% Hispanic. The median face to face time oncologists spent during a GoC encounter with an advanced cancer minority patient was 12 minutes compared to 17 minutes for non-minorities (p=0.002). Median encounter times varied between the four sites, ranging from 10 minutes to 18 minutes, p=0.009. For visits that took place after progression of disease, duration of visit was 18 minutes versus 13 minutes if there were no progression, p=0.007. After controlling for clustering of the patients within the hospitals and progression of disease, time spent with minority patients remained less than with non-minority patients (15 min vs. 18 min, p=0.02). Conclusions: Oncologists' time spent conducting GoC conversations with minority cancer patients is significantly less than with non-minority patients. Evaluating factors that contribute to this disparity is critically important to ensure minority patients receive high-quality cancer care. Clinical trial information: NCT02374255.
Switching endocrine therapy in breast cancer as a strategy for musculoskeletal symptoms, tolerance, and adherence.
Authors: Kibirova Albina , Hall Samantha , Miah Abdul , Salkeni Mohamad Adham 
Published: November 2018

192 Background: Adverse effects of endocrine therapy (ET), especially musculoskeletal symptoms (MSS), represent the major cause of treatment discontinuation in breast cancer (BC) patients, resulting in increased risk of recurrence. Aromatase inhibitors (AI), the mainstay of ET, are associated with a high incidence of MSS such as arthralgia and myalgia. The hypothesis of whether switching ET subclass improves adherence and symptoms was tested. Methods: We conducted a retrospective single site chart review of female patients with nonmetastatic BC, who were seen at Cancer Clinic from January to June of 2017. All patients received AI as a first choice of adjuvant ET; those with disease recurrence while on ET were excluded. We collected data on baseline health, adherence and discontinuation rate, as well as whether switching to a different ET agent (another AI or tamoxifen) was attempted. The subsequent compliance and symptomatology after switching were assessed. Results: 483 eligible patients were identified and divided into 4 groups based upon adherence: 354 (73.3%) were found to be compliant with AI without interruption, 109 (22.5%) switched to a different ET and remained compliant (≥ 1 switch), 16 (3.3%) eventually discontinued ET despite attempting ≥ 1 switch, and 5 patients (1.0%) stopped treatment without a switch. On comparison of the different groups, patients who permanently discontinued ET were more likely to be elderly and have preexisting musculoskeletal condition. MSS was found to be the single most common cause for AI intolerance (105 patients, 81.4%). The median time to switch was 6.3 months (0.3-63.9). Among the compliant switchers, most needed only 1 switch (79) but there were patients who required 2 or 3 switches (23 and 6, respectively). Majority of patients switched from anastrozole to exemestane (84, 51.8%). Significant improvement in symptoms after the switch was reported by 73.3% of patients. Conclusions: Switching between different ET subclasses is an effective treatment strategy to alleviate side effects and enhance adherence to ET. A higher compliance rate of 95.8% was observed in our study compared to a national average estimated at < 80%.
Examination of the Screener and Opioid Assessment for Patients with Pain-Short Form (SOAPP-SF) in an oncology palliative medicine clinic.
Authors: Greiner Rebecca , Boselli Danielle , Salib Mariam , Patel Jai Narendra 
Published: November 2018

196 Background: The National Comprehensive Cancer Network states opioids can be used to treat cancer pain and prescribers should identify patients at risk for opioid misuse; research in this area is limited. In the non-cancer population, SOAPP-SF is a validated tool to predict aberrant drug behavior; a score of ≥ 4 (out of 20) is considered high risk. We performed a retrospective observational study to determine the utility of the SOAPP in identifying opioid misuse in the oncology population as measured by a non-compliant toxicology screen. Methods: Consecutive consults seen during a 6-month period completed the 5-question SOAPP-SF and Edmonton Symptom Assessment System (ESAS) form. Toxicology screens assessed non-compliance (i.e., absence of prescribed medications and/or presence of non-prescribed or illegal substances). Logistic regression models estimated the associations of composite and individual SOAPP-SF scores and ESAS symptom scores with non-compliant screens. Threshold analysis were conducted to identify an optimal SOAPP-SF cutoff. Results: Of 192 consults, 64 patients providing SOAPP-SF score and toxicology screen were evaluable. Mean age was 59 ± 9.8 years: 56% were female, 34% and 62% were African American and Caucasian respectively. Median SOAPP-SF score was 2 (range: [0, 12]). Non-compliant screens were observed in 31% of patients. The area under the curve (AUC) was 0.65. The validated SOAPP-SF cutoff score of ≥ 4 was associated with a sensitivity and specificity of 0.43 and 0.79, respectively (p = 0.082). Sensitivity (0.76) and specificity (0.72) were maximized at a cutoff score of ≥ 3 (p < 0.001). When evaluated individually, the SOAPP-SF question about smoking habit was associated with a non-compliant screen (p = 0.020). Increased ESAS pain scores were associated with SOAPP-SF score ≥ 3 (p = 0.013). Conclusions: SOAPP-SF can identify oncology patients at risk for opioid misuse. Preliminary analyses suggest a more appropriate threshold of identification is a score of ≥ 3 not ≥ 4. Future work will increase numbers of evaluable patients and examine other factors associated with opioid misuse.
Willingness to bear adversity and beliefs about the curability of advanced cancer.
Authors: Loh Kah Poh , Mohile Supriya Gupta , Epstein Ronald M. , McHugh Colin , Flannery Marie Anne , Culakova Eva , Lei Lianlian , Wells Megan , Gilmore Nikesha , Babu Dilip Sankar , Conlin Alison Katherine , Thomas Melanie B. , Berenberg Jeffrey L. , Duberstein Paul 
Published: November 2018

20 Background: Older patients with advanced cancer who are certain that they could be cured pose unique challenges for physicians who wish to help them prepare for death. By estimating the prevalence of absolute certainty about curability (ACC) and examining its correlates we aim to inform the development of interventions to improve end of life care. We hypothesized that patients who report greater willingness to bear adversity in exchange for longevity will be more likely to demonstrate ACC. Methods: This is a cross-sectional analysis of a nationwide geriatric assessment trial. Patients were asked: “What are the chances the cancer will go away and never come back with treatment [100% (ACC), > 50%, 50/50, < 50%, 0%, or unclear].” We assessed willingness to bear adversity using two types of trade-off questions. For trade-offs between treatment-related adverse reactions and survival, five statements on specific adverse reactions (nausea/vomiting, assistance with activities, bedbound state, confusion, worsening memory) were administered. For trade-off preferences between quality of life (QoL) and survival, patients answered the following statement: “Maintaining my QoL is more important to me than living longer”. Logistic regression was used to assess the independent associations of patient trade-off preferences with ACC, after controlling for covariates. Results: 349 older patients were included; 8.0% had ACC. 7.4% of respondents disagreed/strongly disagreed with the statement “Maintaining my QoL is more important than living longer.” Patients who were willing to trade QoL for survival were more likely to demonstrate ACC (AOR 4.43, 95% CI 1.13-17.42). Trade-off preferences between adverse reactions and survival were not associated with ACC. Non-white race, < high school education, lower household income, lack of social support, intact functional status, and no polypharmacy were associated with ACC (p < 0.05). Conclusions: Patients with advanced cancer who are more willing to accept a decreased QoL for survival are more likely to be certain that they will be cured. Beyond sharing prognosis, clinicians might help patients improve prognostic understanding by helping them identify and articulate their values and beliefs.
Impact of parenteral opioid shortage on opioid prescriptions among patients seen by the palliative care team of a comprehensive cancer center.
Authors: Haider Ali , Qian Yu , Lu Zhanni , Naqvi Syed Mussadiq Ali Akbar , Zhuang Amy , Reddy Akhila Sunkepally , Dalal Shalini , Arthur Joseph Anthony , Tanco Kimberson Cochien , Dev Rony , Williams Janet L. , Wu Jimin , Liu Diane D. , Bruera Eduardo 
Published: November 2018

201 Background: Recent parenteral opioid shortage (POS) has the potential to impact cancer pain management in hospitalized patients. This study aims to compare changes in the opioid prescriptions by the inpatient palliative care (PC) team before and after the institution first reported the POS. Methods: We reviewed and compared the electronic health records of 386 consecutive eligible consultations seen by the inpatient PC team equally in one month before and after the announcement of POS on February 8, 2018. The eligibility criteria include (1) cancer diagnosis, (2) ≥18 years of age, (3) taking opioid medication at the time of consultation, and (4) having at least two consecutive visits with the PC team. Patient demographics, cancer type, opioid type, route, and dose defined as the morphine equivalent daily dose were assessed. Results: POS was associated with less use of parenteral opioids (patient controlled analgesia, and intravenous breakthrough) and more use of non-parenteral opioids (extended release, transdermal, and oral breakthrough) by the referring oncology teams, and PC team (P≤.001) (Table 1). At first PC follow-up, significantly less proportion of patients achieved better pain control after POS [119/193 (62%) versus 144/193 (75%) (P=.006)] However, at second PC follow-up, the proportion of pain improvement was similar in both cohorts. Conclusions: There is a significant change in opioid routes associated with POS. POS was associated with worse analgesia. More research is needed to better understand the impact of POS on cancer pain management.[Table: see text]
Evaluation of the effectiveness of a new medical device containing verbascoside, polyvinylpyrrolidone, and hyaluronic acid in prevention and treatment of mucositis in patients with cancer.
Authors: Nigro Olga 
Published: November 2018

206 Background: Mucosal injury is the consequence of biologic events coupled with the influence of the oral environment and microbiome. Oral mucositis is one of the most common toxicities of chemoradiation therapies. Incidence and severity varies by chemoradiation regimens, radiation fıelds, and tumor site. The influence of mucositis on quality of life is greater among patients than the medical literature would suggest. Lack of experience in evaluating treatment toxicities is a daily problem in cancer patients. The aim of this study was to assess the efficacy of verbascoside’s (mucosyte) oral solution on mucositis in cancer patients. Methods: Fourty-five patients with different grade mucositis treated with mucosyte (ranging from 1-2 to 6-7 rinses/day, according to the guidelines) were evaluated from October 2017 to June 2018. Patients were monitored every week until complete remission. Results: Of 45 patients enrolled, 5 had G1 oral mucositis at baseline, 21 had G2, 13 had G3 and 3 had G4. Three patients had G0 oral mucositis at baseline. Median age was 66.8 years. Six patients were treated with carboplatin/paclitaxel, and six with cisplatin/pemetrexed for non-small cell lung cancer; nine patients were treated with paclitaxel, six with adriamycin/cyclophosphamide, and two with eribulin for breast cancer; four patients were treated with FOLFOX for intestinal adenocarcinoma; three patients were treated with nab-paclitaxel/gemcitabine for pancreatic cancer; five patients were treated with cisplatin/cetuximab, and four with cisplatin/cetuximab plus radiotherapy for squamous-cell head and neck cancer. All patients reached complete remission in a median time of 14.9 days (10-24 days). Conclusions: Mucosyte treatment was able to rapidly shorten G3/4 oral mucositis to G1/2, and to never happen mucositis in G0 at baseline. Thus, we suggest that mucosyte can be effective both in prevention and treatment of mucositis.
More opioids, more constipation? Evaluation of longitudinal total oral opioid consumption and self-reported constipation in patients with cancer.
Authors: Ma Joseph , Sera Chris , Roeland Eric 
Published: November 2018

211 Background: Constipation is a distressing physical symptom inadequately assessed in patients with cancer. Total opioid consumption may impact opioid-induced constipation (OIC) prevalence. This study examined total daily opioid consumption on self-reported constipation in patients with cancer. Methods: We performed a retrospective analysis in patients who had a histologically-confirmed cancer diagnosis and completed at least 2 outpatient PC visits at an academic palliative care (PC) clinic. At each PC visit, we collected self-reported constipation scores (11-point scale, 0 [no symptom] to 10 [worst symptom]) and 24-hour oral morphine equivalents (OME) for up to 5 visits. Spearman correlation examined the association between OME and presence of constipation rated ≥3 and Wilcoxan-Mann-Whitney examined OME between patients with or without constipation. Univariable logistic regression examined associations of independent variables on constipation. Results: We identified 404 patients with cancer (mean age 55.5±14.3 years, 61.9% women, 89% metastatic disease). The most common cancer types were gastrointestinal (n = 115; 31%) and gynecologic (n = 47; 13%). Stimulant laxative use was observed in 172 (44.9%) patients. Across all visits, we observed a weak association between OME and patient-reported constipation score (r = 0.16-0.24, p < 0.05 for 4 of 5 visits). Mean OME increased, while mean constipation score decreased across visits. At the first visit, higher mean OME was seen in patients who self-reported constipation (128.8 vs 92.3; p < 0.05). In contrast, for each subsequent clinic visit there was no difference in mean OME in patients with or without constipation. Age, sex, metastatic disease, and stimulant laxative use were not associated with constipation. Conclusions: A weak association was observed between OME and self-reported constipation in cancer patients across multiple palliative care visits. Except for the first clinic visit, there was no difference in OME and self-reported constipation scores. These results suggest a lack of a clear association between total opioid consumption and patient-reported constipation.
Random versus targeted urine drug testing among cancer patients receiving opioid therapy at a supportive care clinic.
Authors: Arthur Joseph Anthony , Lu Zhanni , Hui David , Nguyen Kristy , Prado Bernard Lobato , Edwards Tonya , Yennu Sriram J. , Reddy Suresh , Liu Diane D. , Bruera Eduardo 
Published: November 2018

221 Background: Although urine drug testing (UDT) is an effective risk monitoring tool for patients on chronic opioid therapy, there is currently no evidence to guide physicians in identifying who should have UDT, or when and how often it should be ordered. The main objective of our study was to describe the characteristics of patients who underwent random UDT and a similar cohort who underwent targeted UDT. Methods: Demographic and clinical information of 212 patients who underwent random UDT was retrospectively reviewed and compared with 88 patients who underwent targeted UDT. Targeted UDT was ordered based on the physician’s estimation of patient risk for nonmedical opioid use. All patients were eligible for random UDT regardless of their risk potential for nonmedical opioid use. Results: 212/231 (92%) eligible patients underwent random UDT. Of these 59 (28%) had abnormal results. Among 64 abnormalities detected, 14 (20%) were prescribed opioids that were absent from the urine, 19 (30%) were unprescribed opioids that were present, and 32 (50%) were illicit drugs (91% marijuana). 38/88(43%) of targeted patients had abnormal results. Among 49 abnormalities detected, 13 (27%) were prescribed opioids that were absent from the urine, 15 (31%) were unprescribed opioids that were absent, and 21 (43%) were illicit drugs (71% marijuana). UDT abnormalities were significantly higher in the targeted group than the random group (43.2% vs. 27.8%, p=0.01). There were no significant differences in demographic and clinical characteristics between random and targeted patients with abnormal UDT findings. UDT abnormality was independently associated with age (OR= 0.97 per year, 95% CI: 0.95-0.99, p=0.012), female gender (OR=0.47, 95% CI: 0.28-0.81, p=0.006), anxiety (OR=1.11per point, 95% CI: 1.01-1.22, p=0.039), and appetite (OR= 1.14 per point, 95% CI: 1.04-1.26, p=0.006). Conclusions: More than 1 in 4 cancer patients who underwent random UDT had abnormal results. UDT abnormality in randomly selected patients were no different from targeted patients. Further studies are needed to guide clinical practice regarding standardization of UDT ordering among patients with cancer.
Let’s chat: Piloting an approach to patient-caregiver goal discussions in a neuro-oncology clinic.
Authors: Reblin Maija , Ketcher Dana , Taber Jennifer M. , Cloyes Kristin G , Baucom Brian R , Clayton Margaret F. , Ellington Lee 
Published: November 2018

28 Background: Communication is important to fostering joint coping in patients with advanced cancer and their family caregivers. Joint goal setting has been shown to enhance relationship quality for dyads and increase interpersonal ease and connection. Often patients and caregivers indicate they wish to discuss issues together but have difficulty doing so, which can inhibit dyadic coping and achievement of treatment goals and interpersonal plans. The aim of this study was to determine the feasibility and describe the methods of a short, one-time goal communication intervention for neuro-oncology patients and their primary family caregivers. Methods: Participants were recruited from a neuro-oncology clinic at an NCI-Designated Comprehensive Cancer Center. After informed consent from both patient and caregiver, the dyad was taken to a private room to complete a demographic questionnaire, eight-minute self-directed dyadic discussion of goals, and post-discussion questionnaire. For the discussion, dyads were asked to create and discuss three goals they had for themselves, and three goals they thought their partner would list, with at least one non-cancer related goal. Results: 10 dyads (n=20) were recruited for this study. Participants were mostly white, non-Hispanic, and married spouses. Only one patient participant was unable to list three goals. Dyads reported that the discussion was not stressful and they found high levels of benefit. Analysis of questionnaire and open-ended feedback overwhelmingly indicated the discussion task was useful to participants and that the study environment encouraged open, non-confrontational communication. Conclusions: Our brief prompted dyadic discussion intervention was feasible to implement and participants reported it was useful. Communication between advanced cancer patients and caregivers is vitally important to facilitate dyadic coping and ensure dyads are better able to achieve their goals. This pilot could be easily adapted to facilitate dyadic communication longitudinally to help facilitate communication between patients and caregivers along the cancer care continuum.
Gender and preferences for palliative care: Perceptions of efficacy.
Authors: Korotkin Brittany D. , Perry Laura M , Kazan Adina S , Atiya Wasef , Duberstein Paul , Saeed Fahad , Hoerger Michael 
Published: November 2018

34 Background: Palliative care is underutilized by patients with cancer. Understanding differences in preferences is critical for promoting access. This study tested the hypothesis that women would be more favorably disposed toward palliative care than men. Methods: Two samples of individuals with cancer ( N = 633 and N = 413) provided data on demographics and self-reported health and completed the Palliative Care Preferences Scale, a multifaceted assessment that measures emotional, cognitive, and behavioral aspects of preferences. We conducted t-tests to examine gender differences in palliative preferences in each sample, and analysis of covariance to examine the difference while controlling for age, race/ethnicity, education, cancer type, time since diagnosis, and presence of metastases. Results: As hypothesized, t-tests revealed a significant difference of palliative care preferences across gender for both samples ( p < .001 and p = .020) with women preferring palliative care more so than men. Findings were comparable when controlling for age, race/ethnicity, education, cancer type, time since diagnosis, and presence of metastases ( p = .018 and p = .015). Analysis of the cognitive subscale revealed that relative to men, women viewed palliative care as more efficacious ( p < .001 and p < .001). Conclusions: Findings across the two samples demonstrate greater preferences for palliative care among women than men. Future research should examine whether psychoeducational interventions can be tailored based on gender to increase preferences for palliative care.