bluuebunny/crossref_metadata_2025_split huggingface dataset:
Employing electronic health record data to predict risk of ED visits for new patients.
Authors: Daly Robert Michael , Gorenshteyn Dmitriy , Gazit Lior , Sokolowski Stefania , Nicholas Kevin , Perry Claire , Adams Lynn , Baldwin Abigail , Katzen Lauren L. , Chiu Yeneat O. , Reidy Diane Lauren , Simon Brett A , Perchick Wendy , Wagner Isaac 
Published: November 2018

144 Background: Acute care accounts for half of cancer expenditures and is a measure of poor quality care. Identifying patients at high risk for ED visits enables institutions to target symptom management resources to those most likely to benefit. Risk stratification models developed to date have not been meaningfully employed in oncology, and there is a need for clinically relevant models to improve patient care. Methods: We established a predictive analytics framework for clinical use with attention to the modeling technique, clinician feedback, and application metrics. The model employs EHR data from initial visit to first antineoplastic administration for new patients at our institution from January 2014 to June 2017. The binary dependent variable is occurrence of an ED visit within the first 6 months of treatment. From over 1,400 data features, the model was refined to include 400 clinically relevant ones spanning demographics, pathology, clinician notes, labs, medications, and psychosocial information. Clinician review was performed to confirm EHR data input validity. The final regularized multivariate logistic regression model was chosen based on clinical and statistical significance. Parameter selection and model evaluation utilized the positive predictive value for the top 25% of observations ranked by model-determined risk. The final model was evaluated using a test set containing 20% of randomly held out data. The model was calibrated based on a 5-fold cross-validation scheme over the training set. Results: There are 5,752 antineoplastic starts in our training set, and 1,457 in our test set. The positive predictive value of this model for the top 25% riskiest new start antineoplastic patients is 0.53. The 400 clinically relevant features draw from multiple areas in the EHR. For example, those features found to increase risk include: combination chemotherapy, low albumin, social work needs, and opioid use, whereas those found to decrease risk include stage 1 disease, never smoker status, and oral antineoplastic therapy. Conclusions: We have constructed a framework to build a clinically relevant model. We are now piloting it to identify those likely to benefit from a home-based, digital symptom management intervention.
iOS data app for supportive care in cancer.
Authors: Butler Thomas Wayne , Najera Lucas 
Published: November 2018

148 Background: Providers in oncology must optimize time to serve as many patients as possible daily with the caveat that patient outcomes and satisfaction is paramount. However, a paucity of tools are available to evaluate efficiency. An objective analysis of productivity and patient flow would optimize staff utilization, resulting in an increase in quality and economics of patient care. Methods: Patient flow in a supportive care clinic was recorded manually to delineate patient flow and staff productivity. This method provided baseline data for analysis. An iOS app was then created which can be adjusted to gather data and measure the flow in the clinic prompting patients to complete a questionnaire in the waiting room. The application stores the weather and driving distances to determine how these possibly correlate with efficiency. Additional data points were identified to trend staffing schedules and patient flow. Data inputs include diseases, characteristics, family dynamics and other clinical demographics for analysis and deliverables received. Results: The application generates reports for any variable collected, with a predefined daily report to compute the total relative value units (RVU) of the visit, the total cost and RVUs distribution by provider and/or staff. A percent profit or loss illustrates “value” created by individual objects and staff. The application interprets changes in efficiency over time. In the preliminary results we found direct intervention with the patient and record taking to be the primary deterrent to efficiency and having adequate oncology nursing staffing was most conducive with physician wait times varying significantly with changes in oncology staffing. Conclusions: This tool is unique in producing a cost-effective tool to evaluate daily patient flow and staff utilization. It has future applicability in dynamic analysis of how symptom burden and barriers to care in cancer patients effects the economics of a supportive care clinic. This production of real time information will provide data to improve efficiency, outcomes of care. We plan a pilot study in the supportive care clinic to further evaluate this tool and its benefit to optimizing flow, and enhance cost-effective, patient-centered allocation of resources in supportive care.
RELAX: An immersion virtual reality relaxation intervention for quality of life improvement in cancer patients.
Authors: Gordon Erlinda Maria , Li Bryan M , Liu Seiya , Chawla Sant P , Liu Seiji M , Liu Stephen M 
Published: November 2018

152 Background: Interventions that reduce symptom distress and enhance positive feelings are crucial for improving quality of life and, conceivably, overall survival of cancer patients. One remedy is the immersive virtual reality relaxation (VR-R) environment/s to inspire an emotion-focused coping mechanism in cancer patients. Herein, we report on our experience with the use of this VR-R intervention in normal volunteers and cancer patient volunteers. Methods: Fifty cancer patient volunteers underwent VR-R training and used the VR-R environment/s for 5 - 30 minutes. VR-R is a software-based simulation, which allows an individual to be placed inside an experience, hearing and interacting with stimuli that correspond with visual images of an artificial world. The VR equipment consists of the Oculus Rift Head Mounted Display (HMD) that enables play of an interactive scenario or game that patients can experience from a first-person perspective (i.e., upon entering the interactive scenario, participants are transported into a virtual, 3D world). After the immersion VR-R intervention, patients reported on their experience during the VR-R intervention by answering a QoL questionnaire created by IFGCURE/Cancer Center of Southern California/Sarcoma Oncology Center. Results: Eight of 50 (16%) patients experienced mild motion sickness as the only adverse event associated with its use. Table 1 shows the emotions that patients reportedly experienced during VR-R intervention. Conclusions: Taken together, the data support the premise that VR-R intervention is safe and may be efficacious in improving symptom distress and quality of life of cancer patients. A phase 1/2 study is planned to evaluate the safety and efficacy of the VR-R intervention in improving quality of life in a larger number of cancer patients. [Table: see text]
Social isolation: Impact on treatment and survival in patients with advanced cancer.
Authors: Moore Sara , Leung Bonnie , Bates Alan , Ho Cheryl 
Published: November 2018

156 Background: Social relationships are an important determinant of health, with impacts on morbidity and mortality in the general population. The influence of social isolation in patients with metastatic cancer is less clear, as are the potential mechanisms of its effect. We sought to examine patient-reported social support in a large unselected population, and explore the impact on outcome. Methods: A retrospective review was completed of all patients with metastatic cancer referred to BC Cancer from 2011-2016 who completed a psychological screen within six months of diagnosis. Social isolation was defined as a positive response to any of five questions about social support: live alone, recently lost spouse/partner, no regular contact with friends/relatives, no one to assist with IADLs, no emotional support. An isolation score was calculated as the number of positive responses. The primary outcome was overall survival (OS). Results: 7,699 patients were included in the study. Baseline characteristics: median age 68, 57% male, 60% received systemic therapy, primary tumor site 4% breast / 37% lung / 28% GI / 13% GU / 18% other. 5191 (67%) patients reported no isolation, and 2,538 (33%) were socially isolated. Patients with social isolation were more likely older (median age 70 vs. 67), female (50% vs. 40%), ECOG ≥2 (34% vs. 30%), and receive no systemic therapy (46% vs. 35%). Median OS was inferior in socially isolated patients at 10.1 m compared to those with no isolation at 13.5 m (p<0.001). In a multivariate model including age, sex, ECOG, systemic therapy, and primary tumor site, the impact of social isolation on OS remained significant (HR 1.06, p=0.04). In an exploratory analysis, increasing levels of social isolation were correlated with reduced systemic therapy uptake (score 0=65% received systemic therapy, 1=56%, 2=53%, 3=47%, ≥4=43%, p<0.001). Conclusions: Socially isolated patients with metastatic cancer have inferior survival, which may be influenced by the reduced use of systemic therapy. Increasing patient social support should be explored as a means to improve the uptake of systemic therapy and its benefits on survival in patients with advanced cancer.
Spirituality, religiosity, and burnout in Latin American palliative care health care professionals (LAPC).
Authors: Delgado-Guay Marvin Omar , Reyes Donoso Maria M , Lopez Saca Mario , Riveros Rios Miriam Elisa , Colautti Norma , Espín Gónzalez Ismariel I , Pastrana Tania 
Published: November 2018

164 Background: Spirituality (S) and religiosity (R) are essential in delivering Quality Palliative Care(PC). There's limited literature regarding Latin American clinicians’ spiritual and religious characteristics, or how these shape their clinical engagement and presence of burnout. Methods: To describe the frequency, intensity and importance of S and R and burnout on the LAPC's practice. From 6/1-12/31, 2017, a crossectional study using an anonymous/voluntary Online Survey was provided to active members of ALCP. We collected and analyzed data regarding demographics, role of S, R, and burnout. Results: 221/353 members from 20 Latin American Countries participated, RR:63%. Median age 47(SD+/-12), 75% were women. 40% Catholic. 58% were physicians, 19% nurses, 12% psychology, and other 12%. The median time of working in PC was 9 years (+/-7). LAPC considered themselves spiritual(median:8/10, range 0-10) and religious (5, 0-10). LAPC considered S/R very important in their lives (9/10, 0-10 and 6/10, 0-10), respectively. LAPC reported that S/R was a source of strength/comfort (9/10, SD+/-2), helped them to cope with their problems (8/10,+/-3), and helped them to keep their quality of life in a stressful work environment (8/10,+/-4). 60% LAPC felt energized and 86% reported not feeling exhausted after taking care of patients who are dying. This is associated with being spiritual (p=0.003) and its importance in life (p=0.025). 86% reported strongly/somewhat agreed with: "I feel called to take care of patients who are dying", this was associated with being spiritual (p=0.044). 31/221(14%) reported being burned out. No significant difference among gender, profession, age, years in PC, or importance of S/R. Having higher (34%) versus not (11%) experience emotional exhaustion after caring of the dying were more likely to report burnout (p<0.000). Those who felt emotionally energized after caring for the dying were less likely to report burnout (p=0.010). Conclusions: Most of LAPC considered themselves spiritual/religious, which has an important role in life and helped them to cope. Low percentage reported presence of burnout. The "call" and feeling energized caring for the dying are associated with less burnout.
Development and evaluation of an innovative creative arts program on a tertiary palliative care unit.
Authors: Nekolaichuk Cheryl , Crowe Kim , Ellerby Trevor , Emery-Thom Bette , Enfield Christine , Killoran Sheila , Muller Viki 
Published: November 2018

167 Background: The use of creative arts in palliative care is a unique psychosocial-spiritual intervention, yet there are limited evaluation studies of these programs. The purpose of this presentation is to describe the development and evaluation of a creative arts program, entitled “Tile Tales,” on a 20-bed tertiary palliative care unit. Methods: The “Tile Tales” program encourages the creative exploration of emotions, values and beliefs through the creation of a visual expression on a ceramic tile, with an accompanying story. In this second phase of a three-phase evaluation, participants (18 years or older) were asked to complete a survey at the end of their experience. Results: Over a two-year period (January, 2016 – December, 2017), 40 tiles were completed by 52 participants. Children under 18 years (n = 16) were excluded from further analysis. Twenty-one of 36 adult participants (58%) completed surveys, consisting of family members (n = 9, 43%), patients (n = 6, 28.5%) and staff (n = 6, 28.5%). Participants rated their experience as very meaningful (M 4.8, SD 0.5, scale 0-5). The three highest average impact scores (scale 0-5) were: raising spirits (M 4.9, SC 0.3), expression of feelings (M 4.6, SD .6) and working through grief (M 4.6, SD 0.7). Qualitative comments included themes of gratitude, leaving a legacy, meaning and connecting with others. Conclusions: This innovative creative arts program benefited patients, family and staff, in the expression of emotions and sharing personal stories. These findings will assist with improving program delivery and future planning of the creative arts in palliative care.
Survivorship care plan visits: Mixed methods analysis of patient surveys.
Authors: Garces Natalie , Goto Daisuke , Farhangfar Carol J. , Eaton Tara 
Published: November 2018

174 Background: Survivorship Care Plans (SCPs) are endorsed by cancer advocacy groups and required for accreditation, yet benefits are unclear. The purpose of this quality initiative was to assess the benefit of SCPs. Methods: From June 2015 to September 2017, survivors who had a SCP visit were surveyed to report their understanding of key survivorship topics pre/post visit; the most valuable information learned and plans to use the information. Descriptive statistics and qualitative analysis were performed. Subgroup analysis was performed for age, insurance, marital status, and race. Wilcoxon signed-rank test computed statistical significance. Results: Of 794 surveys, 657 (83%) were complete and evaluable. Surveys were collected from breast (436 [66%]), lung (45 [7%]), colorectal (33 [5%]), head and neck (25 [4%]), melanoma (24 [4%]), endometrial and ovarian (20 each [3%]), and other (54 (8%) cancer survivors. Statistically significant ( p<0.05) improvements in all questions (Table 1) were noted across nearly all disease sites. Exceptions were endometrial, head and neck, and melanoma, which already had > 75% answering “completely understand” for selected questions pre- SCP visit. Subgroup analysis found no significant differences. Self-management was a theme in the “other” insurance status subgroup (14) qualitative analysis. Four (36%) indicated an interest in information about programs to improve healthy behaviors. Conclusions: There was major positive impact of the SCP visit on patient-reported understanding of all survivorship topics. Providers may benefit from focusing SCP discussion on areas the survivor reports as “some” or “no” understanding pre- SCP visit. Providers should connect survivors to resources to support self-identified needs. [Table: see text]
Using implementation science to initiate survivorship care plan practice change.
Authors: Goracke Olguin Betty , Benes Lindsay L. 
Published: November 2018

175 Background: Failure to address coordination of cancer survivorship care can result in physical disability, emotional distress, and increased health care costs. The Institute of Medicine (IOM) recommended Survivorship Care Plans (SCPs) to improve care coordination among cancer survivors. Despite evidence supporting SCPs there remains limited implementation of SCPs. The use of implementation science, frameworks, and strategies that address contextual and process factors, could improve use of SCPs in oncology clinics (Selove et al., 2016). Methods: This innovation used the Quality Implementation Framework (QIF) (Meyers, Durlak, & Wandersman, 2012) to guide implementation. The QIF outlines steps and strategies for four phases of implementation; initial considerations regarding the host setting, creating a structure for implementation, ongoing structure once implementation begins, and improving future application. Results: During the project period (January 29, 2018 through April 23, 2018), 17 SCP visits were conducted; all 17 patients completed study surveys. In response to, “My health care providers work together as a team to ensure that my needs are met,” 65% reported strongly agree, 29% reported agree, 5% reported disagree, and 0% reported strongly disagree. When asked “My health care providers have informed me of what my follow-up care should be” 65% reported strongly agree and 35% reported agree. Of the 17 PCP surveys mailed, four were returned. In response to “For this patient the SCP helps me coordinate follow-up care,” three PCPs responded “agree.” When asked “For this patient, the SCP helps me provide better care,” three responded “strongly agree.” One PCP reported neutral feelings toward both statements. All PCPs reported SCP helped them better understand cancer treatment given and side effects. Conclusions: Successful SCP implementation, replicating outcomes of trials supporting SCPs, is attributable to the use of implementation science. Results from this project demonstrated SCPs achieved care coordination and patient satisfaction. SCPs enhanced PCPs’ understanding of cancer treatment and side effects which could increase likelihood PCPs discuss survivorship issues, as demonstrated in literature.
TIRED: A randomised controlled trial evaluating efficacy of cognitive behavior therapy and graded exercise therapy in severely fatigue patients with advanced cancer.
Authors: Poort Hanneke , Peters Marlies , Van Der Graaf Winette T.A. , Nieuwkerk Pythia , Van de Wouw Agnes W , Nijhuis-van der Sanden Maria , Bleijenberg Gijs , Verhagen Stans , Knoop Hans 
Published: November 2018

183 Background: Patients with advanced, metastatic cancer frequently suffer from severe fatigue. We assessed the effect of cognitive behavioral therapy (CBT) and graded exercise therapy (GET) on fatigue during cancer treatment with palliative intent. Methods: This randomized study took place between Jan 1, 2013 and Sep 1, 2017 at Radboud University Medical Center (Nijmegen, Netherlands). We enrolled adult patients from nine medical oncology clinics. Eligible patients had advanced cancer and reported severe fatigue (Checklist Individual Strength, subscale fatigue severity [CIS fatigue] ≥ 35) during cancer treatment. Participants were randomized to CBT, GET, or usual care (1:1:1 ratio, using a computer-generated sequence, stratified by study site and minimized for sex). We measured fatigue (CIS fatigue and European Organisation for Research and Treatment of Cancer-Quality of Life Questionnaire-Core 30 [EORTC-QLQ-C30] fatigue), quality of life, emotional functioning, physical functioning (all by EORTC-QLQ-C30), and functional impairments (Sickness Impact Profile [SIP8]) at baseline, 14, 18, and 26 weeks. The primary outcome was CIS fatigue at 14 weeks; secondary outcomes included scores for the aforementioned scales. We registered the trial with TrialRegister.nl (NTR3812). Results: 134 participants completed baseline measures (46 CBT, 42 GET, 46 usual care); 126 completed assessment at 14 weeks. There was a significant difference in CIS fatigue scores between CBT and usual care (-7.22, 97.5% CI -12.73 to -1.72; p = .003, d= 0.72), but no significant difference between GET and usual care (-4.70, -10.24 to 0.85, p = .057, d= 0.44). Secondary outcomes showed significant differences for EORTC-QLQ-C30 fatigue (-13.05 [95% CI -22.12 to -3.97]; p = 0.005), quality of life (10.15 [2.37 to 17.93]; p = 0.11), and physical functioning (7.10 [0.48 to 13.72]; p = 0.036), but not for emotional functioning or SIP8 functional impairments (p's > 0.05). There were no significant differences in secondary outcomes between GET and usual care. Conclusions: The findings support CBT for severe fatigue in patients with advanced cancer during treatment. Clinical trial information: NTR3812.
Opioid dose reduction and pain control with medical cannabis.
Authors: Bulbul Ajaz , Mino Emilio Araujo , Khorsand-Sahbaie Masoud , Lentkowski Lisa 
Published: November 2018

189 Background: The use of medical cannabis (MC) for palliation of symptoms is on the rise in cancer and rheumatological patients. Whether there is a potential for opioid dose reduction (ODR) and or quality of life improvements (QOL) is unclear. Methods: A retrospective cohort was evaluated to understand the pattern of care and QOL outcomes with MC use across rural multidisciplinary practices in New Mexico. MC use (> 1 mo.), EMR interrogation, urine toxicology screening were used to identify patients. QOL questionnaire included a graded pain scale. Morphine equivalent (ME) dose was used to estimate changes in opioid dose. ODR was defined as any reduction of baseline opioid dose. A chi-square was performed to evaluate associations. Results: A total of 133 patients were identified between Jan 2017- May 2017. (M/F) 65/68; median age of 53 (range 20 - 84). Nineteen percent (25/133) had a cancer diagnosis. Pain score improved in 80 % of patients with cancer and in 75% (64/89) of non-cancer patients (x2 0.24 p = 0.62). ODR was achieved in 41% (54/133) of all patients on MC. Of these, 63% (34/54) had a 25% ODR and 37% (20/54) had 26% or more ODR (x2 12.8 p = 0.002). In cancer patients, a 25% ODR was achieved in 73% (x2 0.51 p = 0.771). All patients (15/15) using MC and high dose opioid (morphine equivalent ≥ 50 mg/day) had some ODR. Co-adjuvant NSAIDs with MC improved pain score in 67% of all cases vs 33% among non-NSAID cohort (x2 10.7 p = 0.001). ODR was achieved in 32% of patients with active depression vs 68% of patients without (x2 0.044 p = 0.83). Conclusions: In this rural cohort, MC use led to ODR in 41% of all patients. Depression was a negative predictor of ODR. NSAID use facilitated ODR. It will be important to assess MC toxicity before considering this intervention. This study did not include toxicity data due to the retrospective nature of this study and its inherent limitations. Prospective data are needed to confirm these findings.