bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of a mature palliative service for patients with lung cancer admitted to the ICU.
Authors: Smith Brian James , Jermstad Suzanne , Yun Susan , Goodman Judie R. 
Published: November 2018

102 Background: In 2012 ASCO made the clinical recommendation for patients with stage IV solid organ cancer to receive palliative care consultation (PCC) at the time of detection. This was intended to increase utilization and effectiveness of palliative care. In this study, we estimate the proportion and impact of late "brink of death" PCC for patients with stage III-IV lung cancer admitted to the ICU of a hospital with a Joint Commission approved palliative care program. Methods: Retrospective review of patients with advanced lung cancer (stage III-IV) admitted to ICU in 2015-17. IRB approval was obtained. There were no exclusion criteria within this population. Areas assessed were age, stage, reason for admission, interventions, disposition, length of stay, days in the intensive care unit, palliative care consultation, code status, and documented end of life discussion. Results: A total of 13 patient met inclusion criteria. They were 38% male 62% female with a mean age of 67 years (SD: 14.9). All had prior diagnosis of advanced lung cancer and 92% were stage IV. The most common indication for admission was sepsis (38%). Less than half (46%) had a PCC, and fewer (31%) had a documented end of life care discussion. Even in the minority of patients with PCC, 33% received the PCC on day of death. Full code status was maintained in 77%. 53% expired during admission with only 57% of those that died having palliative care discussion. Conclusions: Even in a mature TJC certified PCC program, less than half of these terminally ill patients received a PCC. There is a chasm between ASCO's goal of early PCC and the reality of palliative care utilization in ICU admitted patients with advanced lung cancer. A possible solution is to initiate triggered palliative consultation for this high mortality population upon admission, with possible expansion to other terminally ill groups. In a world of electronic medical records, it should be possible to arrange a system to flag these patients for direct review by the palliative team to determine appropriateness and then notify the primary team in order to coordinate care.[Table: see text]
Barriers to widespread implementation of patient-reported outcome platforms for cancer patients.
Authors: Park Jungyeon , Chaves Júlia Carolina Almeida 
Published: November 2018

107 Background: Patient-reported outcome (PRO) platforms for cancer patients have shown to be effective in improving overall survival, quality of life, and adherence to medication in studies. However, due to controlled environments and limited regional scope, they do not shed light on the barriers for widespread PRO implementation. This study aims to identify such barriers by studying user demographics and usage patterns of an existing free Brazilian PRO mobile app. Methods: From Dec. 2016 to Jul. 2018, 1,246 cancer patients voluntarily registered on the mobile app downloadable on Google Play Store. Patients could report symptoms, physical activity, hours of sleep, weight, fever, overall well-being, and reasons for gratitude on the app. Other features included alarms for medications and a record of patients' hospitals and medical staff. Data collected by the app were analyzed for primary outcomes of user demographics and app usage patterns. Results: Out of the 1,246 registered patients, 44.1% were between the ages of 20 and 49 while only 11.3% were over the age of 65. Half of the patients never logged symptoms, and only 3.2% recorded symptoms more than 10 times. Physical activity, hours of sleep, and weight were each reported by less than 2% of patients. Surprisingly, 37.7% of patients recorded reasons for gratitude a mean of 3.2 times (SD = 10.3), more than the mean 2.9 times (SD = 8.6) that patients reported symptoms. Reporting overall well-being was the most used feature with 50.3% of patients having used it at least once with a mean of 3.9 times (SD = 17.2). Conclusions: Compared to closed short-term small-scale studies, patients engaged significantly less with the unrestricted open-access PRO platform, in particular geriatric patients. This is a significant barrier to widespread implementation as PRO's efficacy relies on consistent patient reports, and as cancer is more common among the elderly. These issues may be due to lack of guidance and supervision from medical/non-medical staff, absence of education on PRO's purpose, or access to technology caused by regional cultural differences. Further research on the cause of and solution for low patient engagement is needed for successful implementation in less-guided environments.
Prevalence of palliative care consultations in phase I pediatric oncology trials.
Authors: Cuviello Andrea Joan , Beri Andrea , Boss Renee D , Shah Nirali N. , Widemann Brigitte C. , Wiener Lori 
Published: November 2018

108 Background: In 2015 the Psychosocial Standards of Care Project for Childhood Cancer published 15 evidence-based standards for pediatric psychosocial care for children with cancer and their families. One standard endorses incorporation of palliative care to “reduce suffering throughout the disease process, regardless of disease status”. Patients enrolling on phase I studies represent a unique cohort within pediatric oncology, as they generally represent a patient population that has not responded to standard therapies and a chance of cure is limited. Phase I trials, primarily designed to test safety and feasibility, offer a low chance of therapeutic benefit and high risk of death. This study aims to define the prevalence of palliative medicine consultation for phase I patients. Methods: A retrospective chart review of pediatric patients enrolled in a National Cancer Institute (NCI) Pediatric Oncology Branch Phase I clinical trial between 2015-present, using the NIH Biomedical Translational Research Information System (BTRIS). Palliative Care Consult Notes, Advance Directive information, diagnoses and medications were captured. Results: We reviewed the records of 126 phase I patients; 66% were male, 47% were >18 years, 67% had relapsed/refractory leukemia, and 46% are now recorded as deceased. Palliative medicine was consulted in <20% of patients; all consultations were for symptom management, primarily pain control (91%). Only 9% of patients had an advance directive prior to enrollment at the NCI. During therapy at the NCI, an additional 20% of patients completed an advance directive, just over a third (35%) of which were patients who received palliative medicine consultation. Conclusions: Palliative care was infrequently consulted in a highly vulnerable patient population where survival outcomes are poor and disease or therapy side effects are substantial. Efforts to increase the use of palliative care services in this population may improve the quality of life for children and families. Future directions include working to standardize the involvement of palliative medicine for pediatric patients enrolling onto phase I clinical trials.
Facilitated access to medical specialist care: The novel approach to support informal hospice caregivers—Analysis of caregivers’ needs and satisfaction.
Authors: Wojtacki Janusz , Janowicz Anna , Krakowiak Piotr , Łabuć Agnieszka 
Published: November 2018

11 Background: Real life observations suggest hospice caregiving may result in physical health deterioration of family caregivers; they are less likely to participate in health-related initiatives and frequently don’t benefit from the most optimal medical care. Data reporting caregivers’ medical needs are rather scarce. Methods: The estimation of needs for specialist medical care aimed at family caregivers was carried out based on the activity called Open Day of Health Prophylaxis (ODHP – free consultations with specialists, ultrasound examinations and mammography) held annually at Rev. Eugeniusz Dutkiewicz SAC Hospice, Gdańsk, Poland during three consecutive years (2014 - 2018). In total, 715 medical consultations (median: 3 per caregiver, range: 1 - 6), 172 ultrasound, and 31 mammogram examinations were provided). The level of satisfaction expressed by the ODHP participants was also analyzed. Demographic, medical data, and involvement in the caregiving were analyzed based on consultation cards and questionnaires presented to all ODHP participants (307 total participants). Results: In total, 186 persons replied (60.59%), 103 of them fulfilled study inclusion criteria (currently or within the last 6 months providing personal care of a chronically ill person for minimum 12 hours per week), 82 (79.61%) of responders were women, most of advanced age (median: 67 years; range: 29 - 91). The vast majority (95.31%) estimated ODHP as valuable initiative. According to 52.23% ODHP completely fulfilled caregivers’ needs and expectations, 45.57% were partly satisfied, and for 2.13% the activity did not meet their expectations. The most common reason for dissatisfaction in the response was both lack of communication and access to specialists, as well inability to initiate other diagnostic tests. All responders indicated the expedient nature of ODHP activity. Conclusions: Facilitated access to medical specialists care in is well received form of support for family hospice caregivers. There is indication of a need for systemic solutions to the problems of medical care for long-term caregivers.
Analysis of prescription pattern of the fentanyl citrate sublingual tablets according to liver or kidney function abnormality of cancer patients.
Authors: Oh Sang-Bo , Oh So Yeon 
Published: November 2018

119 Background: Many advanced cancer patients eventually develop liver dysfunction or renal insufficiency during the course of their disease. However, there is limited evidence for optimally safe drug for pain control in these situation. To estimate the safety of fentanyl citrate sublingual tablets (FSTs) in kidney or hepatic dysfunction, we analyzed whether the total prescription dose or prescription period of FSTs is associated with their liver function test (LFT) or estimated glomerular filtration rate (eGFR). Methods: We retrospectively enrolled consecutive cancer patients who prescribed FSTs at least once from July 2015 to June 2017. Results: Total 611 patients were identified. Median age was 63.6 (18-89) years. Total dose of prescribed FSTs is vary widely among pts; mean 23330 ± 42111 mcg, median 8400 mcg. About kidney function, eGFR could be calculated in 523 patients (85.6%). In 80 pts (15.3%), eGFR is below 60 mL/min/1.73 m2. The total dose of prescribed FSTs have no significant correlation with grade of CKD. The duration of prescription of FSTs was shorter in patients with eGFR < 60 in compared to those with eGFR ≥60; median 42 days versus 66 days (p < 0.001). On the other hand, 535 pts (87.6%) have result of LFT prior to be prescribed FSTs. Significant LFT abnormality is found in 158 pts (29.5%). The total dose of prescribed FSTs have weak negative correlation with LFT level (p < 0.001). The total dose of FSTs is significantly lower in pts with G3/4 LFT abnormality in compared to those with normal or G1/2 LFT abnormality. The duration of prescription of FSTs was significantly shorter in patients with G3/4 liver dysfunction in compared to those with normal or G1/2 liver dysfunction; median 30 days versus 83 days (p = 0.002). In the multivariate analysis, both G3/4 LFT and decreased eGFR are significant factors for shorter duration of prescription by the Cox proportional hazard model. Conclusions: When cancer patients have renal insufficiency or significant liver dysfunction, FSTs were used in a smaller dose for a shorter period of time. We need prospective study on the efficacy and safety of FSTs in cancer patients with liver dysfunction or renal insufficiency.
Prevalence and usage patterns of opiates in patients with lung, breast, and head and neck cancer.
Authors: Westbrook Kyle Andrew , Ahn Chul , Khan Saad A. 
Published: November 2018

120 Background: Prescription opiate abuse is a declared public health emergency, involved in 17,536 deaths in 2015. We don’t know how many cancer patients died from prescription opiates and there is little published data about their prescribing patterns. Methods: Using the UTSW tumor registry, we analyzed all prescriptions for 6424 lung/breast/head and neck cancer patients undergoing therapy including radiation from 2009-2016; patient demographics, cancer information, treatment modality, concurrent medicines, substance abuse history, and survival. Chi-square tests were used to investigate if higher rates of opiate use were seen in those who receive chemotherapy, actively smoke or use alcohol, have head and neck cancer. Results: Opiate use was highly prevalent in cancer patients with 2902/4307 (67%) of women and 1597/2112 (76%) of men requiring opiates. Hydrocodone was the most common opiate at (out of 6424 total) 67%, followed by morphine 12%, fentanyl 9%, oxycodone 7% and hydromorphone 6%. Gabapentin was prescribed to 18.7% of women and 15.9% of men; 494/6424 (8%) patients had 3 or more different opiates prescribed; those who were given gabapentin had a higher rate of 3 or more opiates 249/1241 (20%). Those with current alcohol use required opiates 2001/2643 (76%) compared to those with no alcohol use 2101/3145 (67%) (p<0.0001); while active smokers used opiates 1033/1366 (76%) compared to never smokers 1859/2815 (66%) (p<0.0001). Head and neck patients at 1529/1982 (77%) had higher opiate use than those with breast 1913/2932 (65%) or lung cancer 1061/1510 (70%) (p<0.0001). Patients receiving chemotherapy with their radiation required opiates 696/850 (82%) compared to those who got no chemotherapy 3807/5574 (68%) (p<0.0001). In patients with a radiation course lasting >4 weeks, 8.8% received opiates 12 months after completion of their therapy. Conclusions: More than 70% of cancer patients use opiates after radiation; significantly higher rates of opiate use are seen in those who receive chemotherapy, actively smoke, use alcohol, or have head and neck cancer. Patients treated with radiation for >4 weeks have high rates of opiate use a year after treatment completion.
Toxicity following palliative radiation therapy for painful metastatic bone lesions.
Authors: Jenkins Mikayla , Waddle Mark Raymond , Kaleem Tasneem , Stross William C , Malouff Timothy D , DeVries Matthew , Pacitti Delaney , May Jackson , Patibandla Aditya , White Launia , Spaulding Aaron , Naessens James , Miller Robert Clell 
Published: November 2018

126 Background: Palliative radiation treatment (pRT) is a common and effective treatment for patients with symptomatic bone metastases. However, patients receiving RT for bone metastases often may have a poor performance status and are more likely to experience toxicity during or after treatment. This study aims to investigate the number and type of toxicity event occurring during or after pRT for bone metastases. Methods: Patients treated with RT for bone metastases at Mayo Clinic from 2007 to 2016 were included in this study. Demographic, disease, treatment, and toxicity information were collected. Specifically, toxicity events were identified as emergency department (ED) visits and inpatient hospitalization (IH) within 90 days, breaks in treatment >4 days, and excessive 30 day financial toxicity defined as standardized Medicare costs >1 standard deviation above the mean. RT treatment was compared by dose and fractionation via descriptive statistics. Results: A total of 538 patients treated with pRT were identified, 124 receiving 8Gy x1, 204 receiving 4Gy x5, and 210 receiving 3Gy x10. Patients with breast and prostate cancer were most likely to be treated with 3Gy x10 and patients with GI and Lung cancer were most likely to be treated with 8Gy x1. A description of the patient characteristics and toxicities are shown in Table 1. For 8Gy x1, 4Gy x5, and 3Gy x10 breaks in treatment were rare (0%, 2%, and 3.3%), ED visits (15%, 24%, & 28%), IH (12%, 23%, & 19%), and financial toxicity (13%, 18%, & 21%) were common. A total of 22.6%, 27.5%, and 38.6% of patients were alive two years following pRT from each group. Conclusions: Toxicity during or shortly after pRT of bone metastases is common. This study confirms that additional steps should be taken to monitor and mitigate toxicity in this vulnerable patient group. [Table: see text]
The integrated care service: Impact of a multidisciplinary supportive care service for medical oncology patients in a NCI-designated cancer center.
Authors: Zachariah Finly , Morse Denise , Kinsey Lucia , Koczywas Marianna , Salgia Ravi , Caiazza Sara , Thornhill Austin , Loscalzo Matthew J. , Schnaitmann Natalie , Irish Terry , Prudhomme-Hunter Jill , Banh Dung , Mooney Stefanie , Banerjee Chandana , Patel Purvi , Buga Sorin , Brown Susan , Thomson Brenda , Trisal Vijay , Dale William 
Published: November 2018

134 Background: Palliative care (PC) has shown benefits to inpatient length of stay (LOS), symptom burden reduction, utilization decrease, and time on hospice. It has shown less impact on the rate of hospice referrals. We assessed the impact of an integrated care model on these outcomes. Methods: From Jan-July, 2018, the Department of Supportive Care Medicine collaborated with medical oncology (med onc), nursing and administration to create the Integrated Care Service (ICS). Multi-disciplinary rounds include med onc, supportive care (PC, social work, spiritual care, psychiatry, psychology, hospice liaison), nursing, case management, nutrition, and physical and occupational therapy. The admission criteria include: 1) Later-stage disease; 2) Non-curative intent therapy; 3) High distress burden; and 4) Poor prognosis. The ICS was designed to have geographic co-location, morning PC and med onc rounds, multidisciplinary rounds, and post-acute management. The ICS was compared with other med onc patients (non-ICS) and Mantel-Haenszel Chi-Square statistical significance (p<0.05) was calculated using Epi Info StatCalc. Results: In 6 months, 190 med onc patients (pts) were admitted to ICS versus 537 non-ICS pts. Compared with non-ICS, the ICS pts had a higher Case Mix Index (1.81 vs. 1.56) and metastatic disease incidence (95% vs. 78%, p=0.008). Discharge to hospice was higher from ICS versus non-ICS (23% vs. 7%, p=<0.001), and average time on hospice increased from 9 to 15 days. No chemotherapy was given in the last two weeks of life to any pts on ICS (0 vs. 6 non-ICS pts). Length of stay (LOS) was higher on ICS as compared to non-ICS (8.45 vs. 5.26 days) and readmission rates were similar (12% vs. 13%). Conclusions: For medical oncology pts in a comprehensive cancer center, the ICS, an integrated, multidisciplinary supportive care service, significantly improved discharge rates to hospice, increased LOS on hospice by almost a week, avoided patients receiving chemotherapy, and maintained similar readmission rates. LOS was higher for complex ICS patients as compared to non-ICS. Based on this pilot, the ICS is planning for expansion to include hematology and surgical services.
The cost implications of palliative radiation therapy dose and fractionation for painful metastatic bone lesions.
Authors: Waddle Mark Raymond , Kaleem Tasneem , Stross William C , Malouff Timothy D , Jenkins Mikayla , Pacitti Delaney , DeVries Matthew , Patibandla Aditya , May Jackson , White Launia , Spaulding Aaron , Naessens James , Ma Daniel , Keole Sameer R. , Miller Robert Clell 
Published: November 2018

145 Background: Palliative radiation treatment (pRT) is used for symptomatic bone metastases (mets). Several fractionation schedules show equal efficacy for pain relief, and ASTRO’s Choosing Wisely recommends 8Gy x1, 4Gy x5, or 3Gy x10. This study aims to investigate the cost implications of pRT for bone mets. Methods: Patients (Pts) treated with pRT for bone mets at Mayo Clinic from 2007 - 2016 were included in this study. Costs for all services were subdivided into RT and total costs at 30 & 90 days (30D & 90D). Standardized costs were obtained from the Mayo Clinic Cost Data Warehouse and Medicare reimbursements were assigned to all services with cost to charge adjustments and 2017 GDP Implicit Price Deflator for inflation. Cost means were compared via the Kruskal-Wallis test. Results: 538 pts were treated with pRT, 124 receiving 8Gy x1, 204 receiving 4Gy x5, and 210 receiving 3Gy x10. Pts with breast and prostate cancer were most likely to be treated with 3Gy x10 and pts with GI and lung cancer were most likely to be treated with 8Gy x1. RT costs at 30D were $1,497, $1,891, and $1,982 (p=0.03) and RT costs at 90D were $2,602, $2,753, and $3,032 (p=0.08) for initial RT regimens of 8Gy x1, 4Gy x5, and 3Gy x10. Total costs of care at 30D were similar from $15,969 - 17,687 (p=0.6) and total costs at 90D were similar from $22,361 - 23,219 (p=0.7) between arms. A total of 23%, 28%, and 39% of pts were alive 2 years following pRT from each arm (p=0.07). Conclusions: This is the first study of its kind to analyze actual treatment costs for the three most common pRT regimens in bone mets. Single fraction RT was most used for pts with poor prognoses and was associated with lower RT costs at 30D, but similar RT costs at 90D, possibly due to retreatment. RT choice had no impact on overall costs of care at 30D or 90D. pRT remains of high value, representing only 11-13% of total costs.[Table: see text]
Patients’ education about a new service available at Memorial Sloan Kettering Multidisciplinary Clinic for frail patients with central nervous system cancers.
Authors: Pentsova Elena , Purisic Irma , Zavolas Stephanie , Skakodub Anna , Nevel Kathryn Sara , Kaley Thomas Joseph , Lin Andrew , Daras Mariza , Gavrilovic Igor T. , DeAngelis Lisa Marie , Ruppert Lisa Marie 
Published: November 2018

146 Background: A multidisciplinary clinic (MDC) is a pilot project in the MSK Department of Neurology designed to improve quality of care and patient satisfaction. The MDC enables the patient to receive coordinated care from multiple providers (eg a physical therapist, physiatrist, nutritionist, social worker, case manager, spiritual advisor, and neurologist) in one location in one longer visit. This approach is new, and few patients (pts) have had the opportunity to experience the MDC. We hypothesized that giving the patient information about the MDC will increase the MDC volume. Methods: This is a prospective quality improvement study from June 14, 2018 to July 20, 2018 conducted in four Neuro-Oncology clinics. Pts with primary or metastatic central nervous system (CNS) cancers were identified prior to the visits in their regular oncology clinic. Pts were asked if they were interested in receiving verbal or written information (brochure) about the MDC. For each patient, we recorded if they agreed to receive information, what information they received, and whether they scheduled an appointment at the MDC. We also recorded patient demographics, CNS cancer type, and whether they were accompanied by caregivers. Results: We approached 41 pts. Of the 41 pts, 31(74%) were accompanied by caregivers. Median patient age was 58 (range, 24-79) years. 26 (62%) were female. CNS cancers were primary brain tumors in 31 (76%) and brain metastases in 10 (24%). 27 (64%) of 41 pts agreed to receive both verbal information and a brochure. The remaining 14 (36%) pts did not want to receive more information about the MDC; of these, one patient didn’t take a brochure, 2 pts resided out of the country, and one patient said all needs had been addressed. Within 4 weeks of this pilot study four (15%) of 27 pts scheduled an appointment in the MDC clinic for upcoming dates. Conclusions: Among our pts with CNS tumors visiting their oncologists, 64% were willing to receive information about the MDC, four (15%) made an appointment with the MDC. More study is needed to facilitate education about and access to the MDC; to identify potential barriers; and to obtain longer follow-up.