bluuebunny/crossref_metadata_2025_split huggingface dataset:
Analysis of psychosocial and spiritual concerns in patients consulted for palliative radiation therapy.
Authors: Apkon Dana Jordan , Krishnan Monica Shalini , Abdia Younathan , Hertan Lauren Michelle , Fareed Muhammad Mohsin , Huynh Mai Anh , Parker Gregory McCarthy , Balboni Tracy A. 
Published: November 2018

157 Background: Little is known about the prevalence of psychosocial and spiritual issues in patients being treated with palliative radiation therapy (PRT). This study assessed patients’ psychosocial and spiritual needs as interpreted by radiation oncologists at PRT consultation. Methods: This prospective, survey-based study assessed consecutive consults for PRT from May 19, 2014 to September 26, 2014 at 3 Boston-area community and academic hospitals. Consulting clinicians completed a survey to identify the presence of psychosocial and spiritual issues. 162 consecutive consults were surveyed with 139 psychosocial and spiritual assessments received (86% response rate). Psychosocial and spiritual domains include anxiety, depression, family conflict, family coping issues, personal worries, and spiritual need. Providers ranked the relevance (5-point Likert scale, not at all to extremely) of several palliative care issues, including psychosocial and spiritual issues. Results: Providers reported psychosocial or spiritual problems in 71.4% (n = 100) of consults. Psychosocial concerns were relevant in 68% of consults and spiritual concerns were relevant in 28%. The most frequent problems were anxiety (33.6%, n = 47) and personal issues (33.6%, n = 47), including financial worries. Univariate analysis showed association between psychosocial and spiritual concerns (p = 0.005). Providers treating patients less than 30 days from metastatic diagnosis more commonly reported spiritual concern (p = 0.020). Advanced care planning needs were also predictive of spiritual concerns (p = 0.026). At initial consult, 53% (n = 73) of providers ranked psychosocial problems as “Extremely” or “Very Important” to patient care. 10% of providers ranked spiritual problems as “Extremely” or “Very Important.” Conclusions: Providers noted relevance of psychosocial and spiritual issues to patient care. Given the prevalence of psychosocial and spiritual concerns in this population, it will be important for palliative providers to assess their patients routinely. The variability of predictors demonstrates the appropriateness of assessing all patients consulted for PRT for psychosocial and spiritual concerns.
Relationship processes and symptom burden in couples coping with metastatic lung cancer.
Authors: Milbury Kathrin , Yang Chanyi , Liao Zhongxing X. , Tsao Anne S. , Bruera Eduardo 
Published: November 2018

169 Background: Attachment style is a complex behavioral control system rooted in neurophysiological processes which guides a person’s ability to elicit and respond to emotional closeness in an intimate relationship. Patients with high attachment anxiety and/or avoidance may engage in interpersonal behaviors that exacerbate their stress response and perhaps symptom burden. We hypothesized that, while patients’ insecure attachment is associated with increased symptom burden, partners’ positive relationship behaviors may protect against this association. Methods: Patients with metastatic NSCLC and their partners completed cross-sectional surveys assessing attachment (ECR) and emotional closeness during cancer-related discusssions (PAIR). Patients completed the MDASI to measure cancer-related symptoms. We used multi-level modeling for the dyadic analyses. Results: 54 patients (51% female; 80% White; µ age = 65 yrs) and their partners (51% female; 68% White; µ age = 64 years; µ relationship length = 27 years) participated. Patients with high attachment avoidance reported significantly higher cancer symptoms compared to those with secure attachment (MDASI µ’s: 2.14 vs .21, respectively; P<.05). Cancer symptoms were also significantly higher for patients whose partners reported low compared to high closeness during cancer-related discussions (MDASI µ’s: 1.08 vs .42, respectively; P<.05). In fact, there was a significant interaction between partners’ perceptions of closeness and patients’ attachment avoidance (P<.01) so that only patients with high avoidance reported significantly greater symptom burden if their partners reported low closeness (high avoidance and low closeness: MDASI µ = 2.73; high avoidance and high closeness: MDASI µ = 1.32). Conclusions: Patients’ attachment avoidance is significantly associated with their symptom burden. Partners who are able to maintain closeness during cancer-related discussions may protect patients with high attachment avoidance from experiencing increased symptom burden. Teaching partners of patients with insecure attachment to stay emotionally connected during cancer-related discussions may be an important target for psychosocial interventions.
Memorial Sloan Kettering-Frailty Index (MSK-FI): Validation and its relationship with postoperative outcomes of older survivors of cancer.
Authors: Shahrokni Armin , Tin Amy , Alexander Koshy , Sarraf Saman , Afonso Anoushka , Filipova Olga , Harris Jennifer , Downey Robert J. , Vickers Andrew , Korc-Grodzicki Beatriz 
Published: November 2018

172 Background: Older cancer patients are at higher risk for poor postoperative outcomes. We tested the validity and utility of Memorial Sloan Kettering-Frailty Index (MSK-FI) in this setting. Methods: In a single institution, prospective cohort study, patients age 75+ received comprehensive geriatric assessment (CGA) by the Geriatrics service during preoperative evaluation. The MSK-FI was developed based on the modified Frailty Index, incorporating 10 comorbid conditions and one item related to basic and instrumental activities of daily living. With the total score ranging from 0 to 11, a score of ≥ 3 was considered frail. We validated the MSK-FI against the CGA, and assessed the relationship between MSK-FI frailty with short term (hospital length of stay (LOS), intensive care unit (ICU) admission) and long-term (overall survival) postoperative outcomes utilizing multivariable linear, logistic, and cox regression models, adjusting for age, duration of surgery, American Society of Anesthesiologists physical status classification, and preoperative albumin level. Results: In total, 1,137 cancer patients (median age 80) were included in the study. The prevalence of frailty based on MSK-FI was 41%. Frail patients were more likely to have poor Karnofsky Performance Status (56% vs. 29%), be dependent in basic and instrumental activities of daily living (72% vs. 40% and 64% vs. 34%), experienced a fall in the past year (30% vs. 18%), have slower gait speed (49% vs. 22%),be depressed (66% vs. 49%), have limited social activity (62% vs. 43%), take ≥ 5 medications (63% vs. 25%), experienced significant weight loss (24% vs. 16%), and suffer from polycomorbid conditions (87% vs. 26%). Frailty was associated with longer LOS in the hospital (1.9 days, p <0.0001) and higher odds of ICU admission (OR = 2.34, p = 0.005). With the median follow up of 12.1 months for survivors, frail patients were at higher risk for overall mortality (HR = 1.67, p < 0.001). Conclusions: MSK-FI is a valid instrument in predicting short and long-term postoperative outcomes of older adults with cancer. Future studies should assess the impact of administering MSK-FI on surgical decision-making, postoperative health care process, and outcomes.
Comparison of health care-related social media and Internet usage between patients treated with curative and palliative intent.
Authors: Magony Alexander , Hueniken Katrina , Kassirian Shayan , Geist Ilana , Paulo Chelsea , Eng Lawson , Smith Elliot Charles , Geist Arielle , Rao Pryangka , Brown M. Catherine , Liang Mindy , Yang Dongyang , Xu Wei , Bender Jackie , Gupta Abha A. , Liu Geoffrey 
Published: November 2018

173 Background: Cancer patients (pts) are increasingly searching online for information and support. Online resource usage and preferences may differ between patients treated with curative versus palliative intent. Methods: Cancer pts completed a cross-sectional survey at Princess Margaret Cancer Centre, assessing their usage and perceptions of social media and the internet with regards to their cancer. Associations between patients’ responses and treatment intent were evaluated univariably (t-tests, chi-squared tests) and multivariably (linear/logistic regression). Results: In a univariable analysis comparing 65 palliative pts (PALL) and 222 curative pts, PALL were more likely to be older (p < 0.001) and less likely to be currently employed or a student (p < 0.001); they were less likely to use the internet (91% vs. 97%, p = 0.03), social media (68% vs. 87%, p < 0.001), and used social media less frequently than curative patients (66% vs. 83%, p = 0.01). PALL were less likely to be interested in an online personal health record (62% vs 76%, p = 0.04) and more likely to indicate that they would not use online information (17% vs. 7%, p = 0.02), compared to curative pts. PALL were more likely to be unfamiliar with social media (20% vs. 7%, p = 0.01), to not know how to use social media (21% vs. 7%, p < 0.001), and to have difficulty finding information (14% vs. 5%, p = 0.03). However, no significant differences by intent were identified after adjustment in a multivariable analysis controlling for age. Conclusions: After the age differences between both groups were adjusted for, there were no significant differences in patients’ online activity nor their perceptions of the trustworthiness, utility, and role of social media, and the Internet. These similarities suggest that online resources for PALL can be developed simultaneously with curative pts.
The lived experience of AYA mothers with advanced breast cancer.
Authors: Lundquist Debra , Berry Donna Lynn , Boltz Marie , Desanto-Madeya Susan , Grace Pamela 
Published: November 2018

176 Background: Little is known about daily life experiences of young mothers with advanced breast cancer. Limited research suggests they face unique challenges differing from those of women at other life stages and with earlier stages of breast cancer. The larger study aimed to describe and interpret the lived experiences of young women with advanced breast cancer to contribute to our understanding of the needs of this population. Their role as mothers emerged as a significant theme. The goal of the overall study was to inform the development of person-centered interventions. Methods: Van Manen’s hermeneutic phenomenological method was employed in this longitudinal qualitative study. AYA women (25-39 years) with advanced breast cancer were purposively recruited via private Facebook groups specifically for women with breast cancer. Enrollment continued until thematic saturation was achieved. Data were collected through one or more semi-structured interviews over 6 months depending upon participant willingness, desire, or ability. Journals were provided to write additional thoughts. Data were drawn from interviews about daily life experiences. A major theme related to their identities as mothers emerged. Results: Twelve AYA women (mean age: 35.9) were included. All were married, had at least one child (10 months -14 years, median: 6.0 years), and most (n=7, 72.7%) worked full-time. Twelve participated in the first interview, 9 in a second interview, and 6 in a third interview. Three returned journals. The meaning of their experiences as mothers is captured by the theme: “ I’m Still Mom” and 7 subthemes: “ it’s so hard”, ” being a mom still”, “ what I can still do”, “there’s not enough time”, “being remembered”, “searching for resources”, and “ it’s not easy for my kids”. Conclusions: Being a mother is the first priority for these AYA women with advanced breast cancer, but they are hindered in their parenting activities by physical effects of their cancer and its treatment, uncertainty about their future, and worry for their children’s future. This study provides a base for further research on daily priorities for this population to inform future interventions to optimize quality of life consistent with their parenting priorities.
The association between physical functioning, symptom burden, and coping strategies with quality of life (QOL) in patients with chronic graft-versus-host disease (cGVHD).
Authors: Sommer Robert , Jacobs Jamie M. , Waldman Lauren , Traeger Lara , Greer Joseph , Vanderklish Julie , Chen Yi-Bin Albert , Spitzer Thomas R. , Temel Jennifer S. , El-Jawahri Areej 
Published: November 2018

178 Background: Allogeneic stem cell transplant survivors with cGVHD experience substantial psychological distress and impairments in QOL. However, the relationship between patients’ physical functioning, symptom burden, coping strategies, and QOL over time is unknown. Methods: We conducted a longitudinal study of patients with moderate-severe cGVHD. We assessed patient-reported psychological distress (Hospital Anxiety and Depression Scale), QOL (Functional Assessment of Cancer Therapy-General), physical functioning (Human Activity Profile), cGVHD symptom burden (Lee Symptom Scale), and coping (Coping Inventory for Stressful Situations) at baseline, 3 months, and 6 months. Using mixed linear effects models, we examined the longitudinal relationship between QOL and physical functioning, cGVHD symptoms, and coping strategies. Results: We enrolled 53 patients with moderate (71.7%, 38/53) or severe (28.3%, 15/53) cGVHD. The rate of clinically significant depression and anxiety symptoms at baseline was 32.1% (17/53) and 30.2% (16/33), respectively, and did not change over time. Patients reported low QOL at baseline [M = 70.33, SD = 18.96], which did not change significantly over time [β = -0.66, SE = 1.11, P = 0.550]. Over time, higher physical functioning was associated with better QOL [β = 0.17, SE = 0.05, P = 0.001], while greater symptom burden was associated with worse QOL [β = -0.38, SE = 0.06, P < 0.001]. While the use of emotion-oriented coping was associated with lower QOL over time [β = -0.70, SE = 0.14, P < 0.001], the use of avoidance-oriented coping was associated with higher QOL over time [β = 0.38, SE = 0.10, P < 0.001]. Task-oriented coping was not associated with psychological distress or QOL. Conclusions: Patients with moderate-severe cGVHD report substantial psychological distress and persistently impaired QOL over time. Higher physical function and lower symptom burden are associated with improved QOL. The use of certain coping strategies was associated with changes in QOL. These data underscore the need for supportive care interventions to promote effective coping and enhance physical functioning in patients with cGVHD.
Supportive care in cancer: Impact of marital status on outcome of end-stage head and neck cancer.
Authors: Simpson Matthew C , Bukatko Aleksandr R , Knewitz Allison P , Donovan Connor L , Adjei Boakye Eric , Osazuwa-Peters Nosayaba 
Published: November 2018

18 Background: The impact of marital status on cancer survival, including head and neck cancer (HNC), has been previously described. However, no previous study has shown whether being married impacts head and neck cancer patients with end-stage disease. The objective of this study was to determine the impact of marital status on survival of patients with stage IVc HNC. Methods: Patients ≥18 years from the Surveillance, Epidemiology, and End Results (SEER) database diagnosed with end-stage (AJCC stage IVc) head and neck squamous cell carcinoma from 2007-2015 ( n=2,886) were included. Kaplan-Meier survival estimated crude survival differences stratified by marital status (married/partnered, never married, divorced/separated, widowed) using log-rank test, and in-between differences were determined using Bonferroni adjustments. Competing risks proportional hazards model determined the effect of marital status on death from HNC while controlling for covariates (age, year of diagnosis, county-level poverty percentage, sex, race/ethnicity, insurance, anatomic subsite, and treatment modality). Results: Patients were predominantly male (81%) and white (65%), with mean age of 62 years. Median overall survival for the cohort was 11 months. The Kaplan-Meier curves indicated at the end of follow-up that divorced/separated (HNSCC-specific survival percentage=13%), never married (8%), and widowed patients (12%) had significantly lower survival than married/partnered patients (20%) (Bonferroni p<0.01). After adjusting for covariates, the proportional hazards model indicated that divorced/separated (aHR=1.16, 95% CI 1.01, 1.33), never married (aHR=1.20, 95% CI 1.07, 1.36), and widowed patients (aHR=1.23, 95% CI 1.02, 1.48) were significantly more likely to die from HNSCC than married/partnered patients. Conclusions: Married patients with HNC enjoy better survival outcomes than those unmarried, and those widowed and divorced have worse outcomes. This study illustrates that supportive care, in the form of being married, impacts patients, including those with end-stage disease.
The association of marital status with suicide among male cancer patients in the United States.
Authors: Osazuwa-Peters Nosayaba , Simpson Matthew C , Bukatko Aleksandr R , Adjei Boakye Eric 
Published: November 2018

181 Background: Suicide rate is among cancer survivors double that of the general United States population, and risk is significantly greater among males than females. Meanwhile, being married confers survival advantage across the cancer continuum, with males benefitting more than females. This study was aimed at determining whether marital status mitigated the risk of suicide among male cancer patients with advanced stage disease. Methods: Male patients with stage IV cancer of nine common cancer sites (prostate, lung/bronchus, colon/rectum, urinary bladder, melanoma of the skin, kidney/renal pelvis, non-Hodgkin lymphoma, head and neck cancer, liver/intrahepatic bile duct) diagnosed from 2007-2015 from the Surveillance, Epidemiology, and End Results 18 database were included. A multivariate competing risks proportional hazards model determined the impact of marital status on suicide while controlling for covariates (age, county-level poverty percentage, insurance status, race/ethnicity, cancer site). This model yielded adjusted hazard ratios (aHR) and 95% confidence intervals (CI). Results: There were 228,627 male patients included, with 330 patients committing suicide. The cohort was predominantly non-Hispanic white (71%), married/partnered (57%), and had an average age of 65 years. In the model including all nine cancer sites, divorced/separated (aHR = 1.92, 95% CI 1.40, 2.62), never married (aHR = 1.98, 95% CI 1.48, 2.66), and widowed patients (aHR = 1.50, 95% CI 1.01, 2.24) were more likely than married/partnered patients to commit suicide. Conclusions: Married cancer survivors with advance stage disease are less likely to die by suicide, highlighting the value of supportive care in cancer survivorship. Unmarried patients with advanced stage disease are candidates for surveillance to mitigate suicide risk.
Relationships between distress and sleep in advanced cancer patients and spouse caregivers.
Authors: Reblin Maija , Gonzalez Brian , Heyman Richard E , Ellington Lee , Vadaparampil Susan Thomas 
Published: November 2018

195 Background: Sleep disturbance is a common problem among individuals with advanced cancer. Distress and sleep disturbance are highly interdependent in spouses. Little research has examined dyadic effects of psychological distress on sleep in patient-caregiver spouses, most of whom sleep together. The goal of this study was to determine how anxiety and depression impact one’s own sleep and partner’s sleep in advanced cancer patients and their spouse caregivers. Methods: As part of a larger study, 86 advanced cancer patients and their spouse caregivers completed surveys on demographics and self-reported health, including sleep duration, and the HADS measure of anxiety and depression. A path analysis was conducted to determine the impact of patient and caregiver anxiety and depression on their own and their partner’s sleep. Results: The majority of dyads were white (n = 79) and all were heterosexual. The patient was female in 25 couples. The average age for patients was 67 and 65 for caregivers; couples had been together an average of 35 years. Patients reported sleeping 7.2 hours/night (SD = 1.7) and caregivers reported sleeping 6.72 hours/night (SD = 1.3). Patient and caregiver sleep was significantly correlated (r = .42, p < .01). Controlling for age, sex, and general health, one’s own anxiety was negatively associated with one’s own sleep duration (patient B = -.12, p = .04; caregiver B = -.13, p < .01), but patients’ anxiety was not associated with caregivers’ sleep duration or vice versa. Individuals’ depression was not associated with their own sleep duration, but patient depression was positively associated with caregiver sleep duration (B = .10, p = .05). Conclusions: This is one of the first dyadic explorations of psychological distress and sleep duration in advanced cancer patients and spouse caregivers. The increase in the caregivers’ reported sleep duration associated with patient depression may be an early indicator of caregiver depression. These findings strongly support further research of the dyadic effects of distress on sleep to identify longitudinal effects on holistic sleep outcomes for spouses coping with cancer.
National trends in opioid-related hospitalizations among patients with cancer.
Authors: Chua Isaac S. , Leiter Richard , Brizzi Kate T. , Coey Charles A. , Mazzola Emanuele , Tulsky James A. , Lindvall Charlotta 
Published: November 2018

199 Background: Cancer patients are routinely prescribed opioids for cancer-related pain. With recent attention to the opioid epidemic, we sought to identify risk factors and to describe the incidence of opioid-related hospitalizations among cancer patients. Methods: Serial cross-sectional study of adult cancer patients with opioid-related hospitalizations using the National Inpatient Sample (NIS) database from January 2006 to December 2014. We identified cancer patients using the International Classification of Diseases, Ninth Revision (ICD-9) codes. We defined opioid-related hospitalizations as ICD-9 codes for heroin poisoning, opioid poisoning, or opioid dependence or abuse in the primary diagnosis field. A logistic regression model identified predictors for opioid-related hospitalizations. We adjusted temporal trends for opioid-related hospitalizations for all-cause hospitalizations among cancer patients. Results: Among 25,443,362 hospitalizations for cancer patients, there were 14,336 opioid-related hospitalizations. Non-heroin opioid poisoning made up 88% of opioid-related hospitalizations. Predictors for opioid-related hospitalizations for cancer patients included drug abuse (OR 9.40, 95% CI 8.28 - 10.66), younger age [age 18 - 29 (OR 4.00, 95% CI 3.10 - 5.17); age 30 - 49 (OR 3.99, 95% CI 3.43 - 4.65)], depression (OR 2.17, 95% CI 1.97 - 2.39), alcohol abuse (OR 1.21, 95% CI 1.03 - 1.41), and year of hospitalization [2009-2011 (OR 1.19; 95% CI 1.07 - 1.32); 2012 - 2014 (OR 1.19; 95% CI, 1.06 - 1.32)]. On average, opioid-related hospitalizations increased by 0.003% per year (p = 0.002). Conclusions: Opioid-related hospitalizations among cancer patients are rare, appear to be increasing over time, and are largely due to non-heroin opioid poisoning. Standardized opioid risk screening based on validated predictors may identify cancer patients with the greatest risk of an opioid-related hospitalization.