bluuebunny/crossref_metadata_2025_split huggingface dataset:
Fractional CO2 laser therapy for genitourinary syndrome of menopause (GSM) in survivors of breast cancer (BC).
Authors: Quick Allison M , Zvinovski Filadelfiya , Hudson Catherine , Hundley Andrew , Evans Cynthia , Suresh Anupama , Stephens Julie , Carpenter Kristen , Ramaswamy Bhuvaneswari , Reinbolt Raquel E. , Noonan Anne M. , VanDeusen Jeffrey Bryan , Wesolowski Robert , Stover Daniel G. , Williams Nicole Olivia , Sardesai Sagar D. , Smith Karen L. , Faubion Stephanie S. , Loprinzi Charles L. , Lustberg Maryam B. 
Published: November 2018

202 Background: Fractional CO2 laser therapy is an emerging treatment for GSM. The objective of this study was to determine the feasibility, tolerability and preliminary efficacy of fractional CO2 laser therapy in BC survivors. Methods: This was a single arm feasibility study of BC survivors with dyspareunia and/or vaginal dryness. Participants received three treatments with office-based fractional CO2 laser on at least 30 day intervals and returned for a one-month follow-up. Feasibility was defined as treatment completion without serious adverse events (SAE) in a minimum of 80% of patients. Primary efficacy was evaluated using the mean change (∆) in the score on the Vaginal Assessment Scale (VAS). Secondary efficacy endpoints included mean ∆ in scores on the Female Sexual Function Index (FSFI) and Urogenital Distress Inventory (UDI). Descriptive statistics (means and 95% confidence intervals (CI) for continuous variables and proportions for categorical variables) were used. Results: The study is ongoing with 65 patients enrolled. To date, 37 patients have completed all study treatments and follow-up. Median age for those who have completed treatment was 57 years (range 34-72). Most were ER/PR positive (78%) and Her 2 negative (81%) with stage I (43%) or II (41%) BC. Ninety-five percent were receiving endocrine therapy, most commonly aromatase inhibitors (73%). No SAEs were reported in the 37 patients who have completed study treatments and their outcomes are as follows. Based on the VAS, 78% reported moderate-severe dyspareunia and 89% reported moderate-severe vaginal dryness at baseline. At follow up, 28% reported moderate-severe dyspareunia and 28% reported moderate-severe vaginal dryness. The VAS score improved from baseline to follow up (mean ∆ 4.1; 95% CI [3.1, 5.1]). Similarly, the FSFI score improved (mean ∆ -10.0; 95% CI [-13.2, -6.9]) and the UDI score improved (mean ∆ -5.7; 95% CI [-10.1, -1.3]). Final efficacy analysis will be reported once all patients have completed all time points. Conclusions: Fractional CO2 laser treatment is feasible and tolerable in BC survivors and may reduce symptom burden from GSM. A randomized controlled trial with sham laser is currently in development. Clinical trial information: NCT03307044.
Association of impairments in activities of daily living (ADLs) with symptom burden, health care utilization, and survival among hospitalized patients with advanced cancer.
Authors: Lage Daniel E , El-Jawahri Areej , Fuh Charn-Xin , Newcomb Richard , Jackson Vicki , Greer Joseph , Temel Jennifer S. , Nipp Ryan David 
Published: November 2018

203 Background: Hospitalized patients with cancer often have impaired ADLs related to age, comorbidities, and both cancer and treatment-related morbidity. However, the relationship between ADL impairment and patients’ symptom burden and clinical outcomes has not been well described. Methods: We prospectively enrolled patients with advanced cancer with unplanned hospitalizations at an academic medical center. Upon admission, nurses assessed patients’ ADLs (mobility, feeding, bathing, dressing, and grooming). We used the Edmonton Symptom Assessment Scale (ESAS) and Patient Health Questionnaire-4 to assess physical and psychological symptoms, comparing symptom burden between patients with and without ADL impairment. We used regression models adjusted for age, sex, education, Charlson comorbidity index, months since advanced cancer diagnosis, and cancer type to assess the relationship between any ADL impairment and hospital length of stay, the composite outcome of death or readmission within 90 days of discharge, and survival. Results: Among 932 patients, 40.2% had at least one ADL impairment. Patients with ADL impairment were older (67.2 vs. 60.8 years, p<0.001), had higher Charlson comorbidity index (1.1 vs. 0.7, p<0.001), and higher physical symptom burden (ESAS Physical 35.2 vs. 30.9, p<0.001). Those with ADL impairment were more likely to have moderate to severe constipation (46.7% vs. 36.0%, p<0.01), pain (74.9% vs. 63.1%, p<0.01), drowsiness (76.6% vs. 68.3%, p<0.01), as well as symptoms of depression (38.3% vs. 23.6%, p<0.01) and anxiety (35.9% vs. 22.4%, p<0.01). In adjusted models, ADL impairment was associated with longer hospital length of stay (B=1.30, p<0.01), higher odds of death or readmission within 90 days (odds ratio=2.26, p<0.01), and worse survival (hazard ratio=1.73, p<0.01). Conclusions: Hospitalized patients with advanced cancer who have ADL impairment experience a significantly higher symptom burden and worse health outcomes compared to those without ADL impairment. These findings highlight the need to assess and address ADL impairment among this population to enhance their quality of life and care.
Prediction of hospitalizations in patients with cancer age 70 and older receiving chemotherapy.
Authors: Voutsadakis Ioannis , Reed Melissa , Patrick Caitlyn , Quevillon Travis , Walde Natalie 
Published: November 2018

216 Background: Chemotherapy is one of the main treatments for cancer and is associated in many cancers with significant benefits in overall and disease-free survival. Nevertheless, it is also associated with adverse effects that may lead to hospitalizations in older patients with comorbidities or decreased general status. We aimed to identify factors associated with hospital admissions in this population. Methods: Records of cancer patients 70 years-old or older who received adjuvant chemotherapy or first line chemotherapy for a cancer in a single center were retrospectively reviewed. Demographic, disease and treatment data were extracted. Factors associated with hospitalizations during chemotherapy treatment were evaluated in a univariate analysis with the x2 or the Fisher’s exact test. Factors identified were fitted in a multivariate regression model. Results: Among the 276 patients included in the study, 117 (42.4%) were male and 159 (57.6%) were female. Most patients (53.6%) were 70 to 75 years-old, but there were also significant proportions of patients that were 76 to 80 years-old and above age 80 (29.0% and 17.4% respectively). Chemotherapy was given in the adjuvant setting in 51.1% of patients and in the first line metastatic setting in 48.9% of patients. Treatment was with single chemotherapy drug in 22.8% of patients and poly-chemotherapy was given in 77.2% of patients. One hundred and six patients (38.4%) had a hospital admission during or up to a month after their chemotherapy treatment. Factors associated with admission in the multivariate analysis included ECOG PS > 1 (p = 0.04, odds ratio 1.4, 95% CI: 1.0-1.9) and hypoalbuminemia (p = 0.03, odds ratio 0.94, 95% CI: 0.88-0.99). Among the 174 patients that had a good PS (ECOG PS = 0 or 1) and normal albumin, only 28.7% had been hospitalized during treatment, while 62.3% of the 77 patients with PS of 2 or 3, hypoalbuminemia or both were hospitalized during or within the month after completion of treatment. Conclusions: Good ECOG PS in combination with a normal albumin is predictive of lower hospitalization rate in cancer patients 70 years-old and older receiving chemotherapy.
Symptom science research conducted in NCI community programs over the past decade.
Authors: St. Germain Diane C. , O'Mara Ann M. 
Published: November 2018

220 Background: With the rising number of survivors across many cancer sites, increasing attention is being paid to assessing, preventing, and managing cancer and treatment related symptoms. This presentation will discuss the breadth of the symptom management portfolio within the community research programs funded by the NCI: The Community Clinical Oncology Program (CCOP) and the NCI Community Oncology Research Program (NCORP) from 2008 to 2018. Trends in types of symptoms and study designs will be described to identify research gaps. Methods: Symptom management research was operationally defined as any clinical study focusing on cancer and treatment related symptoms and/or related psychological, social and spiritual problems. The primary endpoint is measured by a patient reported outcome (PRO). Using this definition, a search was conducted of the NCI database to capture clinical studies implemented in the CCOP and NCORP networks from 2008 to 2018. Results: Between 2008 and 2018, 68 clinical studies were conducted in the NCI community research programs that met this definition. During this period of time, the most frequently studied symptom was neurotoxicities (n = 13), comprised of chemotherapy induced peripheral neuropathy (n = 3), neurocognition (n = 9) and ototoxicity (n = 1). Gastrointestinal symptoms (n = 10), pain (n = 9) and fatigue (6) were the following most frequent. The least studied symptoms included genitourinary symptoms (n = 1), vaginal health (n = 1), sexual desire (n = 1), psychosocial (n = 2) and lymphedema (n = 2). The predominant trial design was phase II or III randomized clinical trial with the remaining longitudinal, cohort design. Further delineation of these data will be presented. Conclusions: The prevalence of the symptoms studied within the NCI community programs mirrors the symptom literature in terms of frequency. Cancer survivors have reported a number of symptoms not adequately addressed by their clinicians such as sexual health and psychosocial issues. This gap also mirrors the frequency of research conducted in the community networks. Future research in the network focusing on these understudied areas should be considered by investigators.
Exercise counseling in integrative cancer care: Effects on patient self-reported symptoms and quality of life.
Authors: Lopez Gabriel , Eddy Carol A , Liu Wenli , Li Yisheng , Chen Minxing , Cohen Lorenzo 
Published: November 2018

227 Background: Exercise has shown benefits for cancer prevention and contributes to improved treatment-related outcomes. We reviewed characteristics of cancer patients referred for physical therapist-led exercise counseling at a comprehensive cancer center and its effects on self-reported symptoms and quality of life. Methods: Patients presenting for outpatient exercise counseling from February 2016 to May 2017 completed the Edmonton Symptom Assessment Scale (ESAS; 0-10 scale, 10 most severe) pre/post-encounter and PROMIS10 global health assessment pre-encounter. ESAS individual items and subscales of Physical Distress (PHS), Psychological Distress (PSS), and Global Distress (GDS) were analyzed. We used paired t-tests to compare: (1) ESAS symptoms before and after each encounter and (2) ESAS and PROMIS10 scores at baseline and first follow-up. Results: Of 350 participants, most were female (77.7%), white (66.3%), and had breast (43%) cancer; 31% had at least one follow-up visit with the physical therapist. Symptom scores at baseline (frequency; mean) included poor sleep (68.2%; 3.5), poor well-being (67.4%; 3.2), and fatigue (64.7%; 3.1). Examination of pre- to post-exercise counseling outcomes revealed statistically, and clinically significant improvement in GDS (-3.32, SD 6.52, p<0.001). On follow-up, statistically and clinically significant improvements were observed for ESAS measures of fatigue (-1.22, p=0.01), GDS (-4.81, p=0.01), and PHS (-3.1, p=0.03) and PROMIS10 global health, mental health, and physical health scores (all p’s<0.05). Conclusions: Patients presenting for exercise counseling had a low to moderate symptom burden and experienced significant improvement in global distress after one encounter. Longitudinal evaluation revealed improvement in global health and fatigue. Additional research is needed to learn more about patient selection and timing of exercise counseling interventions.
Voice of cancer patients (VoCP): Patient perceptions regarding use of marijuana and its derivatives in cancer.
Authors: Aggarwal Sangeeta , Bhowmick Jyoti , Sharma Rishi , Singh Manish , Gond Rahul Kumar , Dash Isa , Aggarwal Alok 
Published: November 2018

228 Background: Despite legal controversies, medical Marijuana use is increasingly accepted for mitigating side effects from chemotherapy in cancer patients. In this study we analyzed cancer patient perception and experience on the use of Marijuana and its derivatives. Methods: We collected 15.7 million freely shared messages from cancer patients from 52 unrestricted web forums. Using our VoCP platform based on techniques artificial intelligence, we processed unstructured text and analyzed these messages to extract relevant information and experiences on the use of Marijuana and its derivatives. Results: Of 15.7 million messages, 27,510 messages from 11,244 distinct users discussed Marijuana and cancer. 2,770 users had firsthand experience and shared 5,251 messages. Overall, 876 users (1,150 messages) were satisfied, 319 users (332 messages) were dissatisfied, and the remaining 1,575 did not say. Common reasons for use of Marijuana included nausea (526), insomnia (526), appetite (165), pain (122), weight loss (102), fatigue (57), anxiety (60), gastroparesis (27), and neuropathy (11). Questions asked by patients were related to people’s experience with marijuana, availability, preparations, efficacy, legality views, and side effects. Common cancer types where marijuana use was discussed were breast (3745), lung (1,476), colorectal (675), head and neck (405), pancreatic (239), stomach/esophagus (485), lymphoma (512), CNS tumors (499), and unspecified type (1,869). Methods of use discussed by ,1338 users and included smoking (875), oils (368), tincture (31), capsules (11), and other edibles (41). Source of obtaining marijuana mentioned as legal organization / licensed practitioner (254), online (34), friends and family (33), and growing ( 34). 1,111 messages discussed availability of marijuana. 2,912 messages discussed legal issues concerning Marijuana. 1,737 said that it is legal in their states and 1,179 said that it is illegal. Conclusions: Marijuana and its derivatives are increasingly being used by cancer patient to mitigate cancer and treatment-related side effects, and the use is increasing as recreational use of marijuana is being legalized in more states.
Prognostic awareness and illness understanding in patients with malignant glioma and their caregivers.
Authors: Landay Sophia , Anand Maya V. , Quain Katharine M. , El-Jawahri Areej , Greer Joseph , Temel Jennifer S. , Forst Deborah Anne 
Published: November 2018

33 Background: Malignant gliomas (MG) are rapidly progressive, incurable tumors. Patients with glioblastoma, the most common MG, have a median survival of approximately 14 months when treated aggressively. Despite this poor prognosis, data is lacking on patients’ and caregivers’ (CGs’) understanding of patients’ prognosis and treatment goals and their communication preferences. We assessed prognostic awareness (PA) in patients with MG and their CGs three months following diagnosis. Methods: We conducted a prospective study in patients with newly diagnosed MG and their CGs. At three months post-diagnosis, we administered to patients and CGs the Prognosis and Treatment Perceptions Questionnaire, which assesses illness understanding, goals of treatment, and likelihood of cure. Results: At three months after diagnosis, 82.9% (68/82) of patients and 81.3% (52/64) of CGs reported that knowing prognosis is “extremely” or “very” important, yet only 42.6% (35/82) of patients and 60.9% (39/64) of CGs reported accurate PA, defined as responses of “unlikely,” “very unlikely,” or “no” chance of cure. 46.3% (38/82) of patients and 46.9% (30/64) of CGs reported that their oncologist’s primary goal was to “extend life as long as possible,” while 25.6% (21/82) of patients and 10.9% (7/64) of CGs stated that their oncologist’s goal was to cure their cancer. Patients’ primary goal was most frequently “to cure my cancer” [40.2% (33/82)], while CGs most often presumed that their loved ones’ treatment goal was to “extend life as long as possible” [43.8% (28/64)]. Conclusions: Patients with MG and their CGs report that PA is important, but most patients, and to a lesser degree their CGs, have inaccurate PA. Additionally, patients’ treatment goals differ from CGs’ perceptions of patients’ goals and oncologists’ presumed goals. Patients’ primary goal is often curative, while CGs frequently presume that their loved one’s goal is to prolong life without aiming for cure. Patients and CGs most often presume that their oncologists are primarily aiming to extend survival rather than cure their disease. Further investigation of interventions to improve conversations about prognosis among patients with MG, their CGs and their oncologists is warranted.
Physician attire and palliative care patients’ perception of physician compassion and professionalism: A randomized controlled trial (RCT).
Authors: Azhar Ahsan , Tanco Kimberson Cochien , Haider Ali , Cantu Hilda P. , Hernandez Carolina Diaz , Rantanen Petra A , Park Minjeong , Liu Diane D. , Williams Janet L. , Bruera Eduardo 
Published: November 2018

39 Background: Environment is important component of communication skills. Physicians’ communication style including attire may influence patient perceptions. Previous studies mostly based on pictures of providers in different attires provide conflicting evidence. This RCT aimed to explore the effects of physician attire on patients’ perceptions of compassion, professionalism and physician preference. Hypothesis was that patients will perceive the doctor in formal attire as more compassionate than the doctor wearing casual attire. Methods: 105 English speaking adult follow-ups at outpatient supportive care center, were randomized to watch 2 standardized, 3-minute video vignettes, with similar script, depicting a routine clinic encounter. In one video, physician was wearing formal attire with tie and buttoned up white coat, while in the other, physician was in casual attire without a tie or white coat. Actors and patients were all blinded to purpose of the study. Investigators were blinded to the videos watched by patients. After viewing each video, patients completed validated questionnaires rating their perception of physician compassion (0 = best, 50 = worst) and professionalism (5 = poor, 25 = very good). Patients were also asked to rate their preference for the physician. Results: There were no significant differences between formal and casual attire for compassion [median (IQR), 25 (10, 31) vs 20 (8, 27); P = 0.31] and professionalism, [17 (13, 21) vs 18 (14, 22); P = 0.42]. 32 (30%) patients preferred formal, 33 (31%) preferred casual attire and 40 (38 %) patients had no preference. Subgroup analysis did not show significant differences among age, sex, marital status and education level for compassion, professionalism and physician preference. Conclusions: Doctor’s attire did not have an effect on patients’ perception of physicians’ level of compassion and professionalism. Dress code also did not influence the patients’ preference for their doctor or their trust and confidence in the doctor’s ability to provide care. There is need for more RCTs in area of communication skills specifically to better understand the impact of different attires on patient perceptions. Clinical trial information: NCT03168763.
Mindfulness training to support advance care planning: Qualitative findings from a randomized pilot.
Authors: Johns Shelley A. , Cottingham Ann H. , Gowan Tayler , Talib Tasneem L. , Stutz Patrick V. , Faidley Micah T. , Maiko Saneta M. 
Published: November 2018

4 Background: Emotional discomfort talking about end of life (EOL) often inhibits advance care planning (ACP). Mindfulness meditation facilitates emotional regulation through present-centered awareness and non-reactive coping and may help adults with cancer and their family caregivers (CGs) approach ACP with greater ease. As part of a randomized pilot study of a mindfulness intervention, we conducted qualitative interviews with cancer patients and their CGs to explore participants’ perceptions of the effects of mindfulness on EOL discussions and ACP. Methods: Adults with advanced solid malignancies and an estimated prognosis of < 12 months were randomized with their CG (N = 55 dyads) to receive standard care alone or standard care plus a 6-session mindfulness intervention that included guided mindfulness meditation, mindful communication practices, and ACP information. A subset of mindfulness patients (n = 20) and CGs (n = 15) completed semi-structured qualitative interviews post-intervention that were recorded, transcribed, and coded using a deductive approach. Results: Researchers identified three primary themes. For patients and CGs, the mindfulness intervention: (1) enhanced awareness and discussion of ACP; (2) increased acceptance of poor prognosis; and (3) fostered supportive communication. Consistent with these themes, patients noted that the intervention enabled them to begin to accept that cure may not be possible, helped them “get over the hurdle” of talking about EOL, and provided an opportunity to reflect on their life priorities, including goals of care. CGs reported that the intervention fostered ACP conversations that had been previously avoided, enhanced understanding of patient preferences that often differed from their own, and increased ability to accept realities of the patient’s illness. Patients and CGs both reported improved understanding of the need to plan for EOL, greater openness to discussing sensitive issues, and an enhanced ability to listen more deeply and communicate with greater kindness. Conclusions: Findings support the use of mindfulness training to equip patients and CGs for timely EOL discussions and ACP. Clinical trial information: NCT03257007.
Cellular phone-based application as a tool in pediatric palliative care.
Authors: Ah Chu SÃ¡nchez MarÃa Sabina 
Published: November 2018

48 Background: Free cross-platform instant messaging is a popular way of communicating in Panama. Is it possible to apply this in Palliative Care (PC)? Methods: This is a descriptive transversal study of some problems we could solve internally with the help of this cell phone-based application. The universe is the total of consultations of the PC Pediatric Support Team in Panamá Children’s Hospital to the National Program of PC from May 2016 to July 2018. First, we developed a chat group, so all 55 members of the national palliative program can share specific information related to PC topics. We describe the most common problems that we can solve with the help of instant messaging technology such as: 1. Presentation of cases at the time of their going-back home from the hospital-team to the community-team. 2. Presentation of urgent cases to the National Aero-Naval Force to be transported by boat or plane. 3. Education of mothers on specific problems they have at home. Results: We had 113 consultations in pediatric palliative care group. Of those, 78% had to be presented to the community-health-care-center (88 cases). The time-of-response was in the range of 5-120 minutes. We had to arrange sanitary transportation by boat or plane in 14% of the cases. Of those cases we obtained a response by the Aero-Naval force in less than 24 hours. We solved specific palliative symptom problems such as: fever, administration of the rescue dose, mucositis, and coping problems in some patients that lived more than two hours from the nearest health-center. For this we used educational videos made for this purpose. Conclusions: Instant messaging technology is used for the provision of palliative care communication, safety transportation and clinical problem solving. It had to be used in conditions that protect the privacy of patients and families. This current study suggest that this is a new opportunity that must be considered for its efficiency in solving specific problems.