bluuebunny/crossref_metadata_2025_split huggingface dataset:
How long do patients with advanced cancer survive after discharge to sub-acute rehabilitation?
Authors: Khan Muhammad Azeem , Stewart Diana , Pettit Clint S. , Groninger Hunter 
Published: November 2018

67 Background: Patients with advanced cancer inevitably experience a functional decline diminishing quality of life. Many are admitted to the hospital due to progression of disease and become further deconditioned. Discharge to sub-acute rehabilitation (SAR) to "gain strength" for future anti-cancer therapy is common as participation in more intensive rehab therapy is rarely possible. In this study, we wished to determine the length of survival after discharge to SAR and if factors such as pre-hospitalization ECOG correlated with increased length of survival. Methods: At our 926-bed urban academic center, we performed a retrospective chart review from June 2015 to January 2017 of hospitalized patients with solid cancers who were subsequently discharged to SAR. Patients were excluded if they had surgery, a cerebrovascular event during their hospitalization or no post-hospital oncology follow-up plan. The primary outcome was death. Results: Fifty-six patients were identified (median age 69, range 28-95; 87% African American; 72% female). Forty-seven (86%) had metastatic disease. Forty-seven patients (86%) were deceased as of June 2017. The mean survival from date of discharge was 114 days (SD 122.89, range 1-447). Twenty-eight patients (51%) had a pre-hospitalization ECOG of 1 or 2 and twenty-seven patients (49%) had an ECOG of 3 or 4. Mann-Whitney U correlation was used to test the correlation between ECOG and survival. Patients with an ECOG of 1 or 2 trended to survive longer (156 vs 75 days, p=0.06). Self identified white patients had a statistically significant longer survival post discharge to SAR compared to African Americans (204 vs 104 days, p=0.03). Conclusions: Compared to patients with ECOG 1 or 2, patients with ECOG of 3 or 4 survived for a fewer number of days. The identification of additional markers of poor prognosis through larger prospective multi-institutional studies will help to delineate which patients are more likely to benefit from discharge to SAR.
The feasibility of an inpatient intervention to improve end-of-life care in gynecologic oncology patients.
Authors: Puechl Allison , Lim Stephanie , Truong Tracy , Havrilesky Laura , Davidson Brittany Anne 
Published: November 2018

69 Background: Unscheduled hospitalizations in patients with advanced cancer predicts < 6 month median survival. Patients with cancer hospitalized near the end of life (EOL) often receive aggressive treatments without survival advantages and have poor quality-of-life. EOL discussions and palliative care (PC) services reduce aggressive care. Methods: An intervention was designed to decrease aggressive EOL care in Gynecologic Oncology (GO) inpatients at a high risk for death within 6 months. Inclusion criteria were advanced gynecologic cancer and 1 of the following: bowel obstruction, failure to thrive, dehydration, cancer-related pain, malignant pleural effusion or ascites, or PCN management. Patients were identified by the care team on admission. An independent auditor assessed if patients were appropriately identified. Eligible patients received a 3-part high risk Gynecologic Oncology (HR-GO) bundle: 1) PC consult, 2) goals of care (GOC) conversation ≤ 48 hours of admission, and 3) PC follow-up within 2 weeks of discharge. Data was collected through chart review. Barriers to bundle implementation were identified. Results: 83 eligible patients were admitted between 8/2017-4/2018. 38 patients (46%) had multiple hospital admissions. 41 patients (49%) received the entire bundle during at least one hospital admission. During their 1st hospital admission, 30% of patients received all 3 parts of the HR-GO bundle. Among those who did not receive the entire bundle, 43% had two components missing. PC follow-up was the most commonly missed component, followed by a GOC conversation within 48 hours of admission. As identified by the auditor, twenty percent of eligible patients were not placed into the study cohort during their first hospital admission. Two barriers to bundle implementation were identified:1) the dependence on care team members to identify high-risk patients and 2) the avoidance of needed GOC discussions when patient’s 1° attending was unavailable. Conclusions: The implementation of an inpatient intervention to decrease aggressive EOL care in GO patients is feasible however barriers must be addressed. Currently work on an automated system to identify patients for intervention is ongoing.
An invitation to complete: Making advance directives part of the new patient process.
Authors: Ash-Lee Susan , Busby Leslie T. , Diab Sami , Taniguchi Cynthia B. , Gorsky Ami 
Published: November 2018

7 Background: In Colorado, there is no legal designation as to who is authorized to make healthcare decisions for an adult unable to make decisions for themselves. Completing an advance directive is increasingly associated with better end-of-life outcomes. Failure to complete an advance directive leads to fewer days on hospice and expensive, end-of-life care. It was hypothesized that patients who completed a Medical Durable Power of Attorney (MDPOA) document early may have higher adoption of advance care planning and earlier hospice at end-of-life. Methods: The Rocky Mountain Cancer Centers (RMCC) is the largest private oncology group in Colorado with multiple offices across the state. The RMCC-Pueblo clinic developed and piloted a new patient process where, at registration, all new patients were invited to complete a MDPOA while also completing other new patient forms. The Medical Durable Power of Attorney (MDPOA) is a document that appoints a healthcare decision maker (“healthcare agent”). Data on 4,441 patients from Nov. 1, 2017, to June 30, 2018, were extracted from the electronic health record (EHR), including code status, advance care planning counseling appointment, advance directive completion, and outcomes. Results: During this pilot, advance directive capture within the EHR rose from 15.4% to 21.4%. While the number of patients who elected hospice enrollment at the end of life was about the same, the length of hospice stay increased from an average of 14 to over 20 days, a 50% improvement. Conclusions: A MDPOA as a routine part of the new patient intake process is feasible and scalable. It opens the door to future ACP discussions and improved hospice utilization. Because of these findings, we are currently expanding this process to all RMCC practice sites. The results suggest that early completion of an Advance Directive lead to ongoing and healthy discussions about the patient’s end-of-life preferences for care, including appropriate hospice enrollment.
Impact of cardiopulmonary resuscitation (CPR) on the survival of patients with cancer: DNR before or after cardiac arrest?
Authors: Giza Dana Elena , Rodrigo Mejia , Crommett John , Botz Gregory , Ewer Michael S. , Iliescu Gloria , Radford Marvin , Cavalier James , Rodriguez Maria Alma , Iliescu Cezar 
Published: November 2018

71 Background: Cardiopulmonary resuscitation (CPR) after cardiac arrest in cancer patients is associated with lower survival rates when compared to non-cancer patients. The quality of life of those who survive after CPR to be discharged is often diminished. Among these patients there is a high likelihood of changing their code status to DNR. Methods: Our study determines the overall survival rate, the survival to discharge rate, and the DNR change rate postcode among cancer patients who underwent CPR in our cancer center. Data was analyzed retrospectively from electronic records of cancer patients who had cardiac arrest and underwent CPR between April 2017 and March 2018 at a tertiary cancer center. The end points included the overall survival immediately after CPR, the survival rate at 24h, the survival to discharge rate, and the DNR change rate postcode. Results: Between 2017 and 2018, a total of 396 codes were registered in cancer patients in our center, out of which 53% had cardiopulmonary arrest as trigger event. In more than 90% of the patients, average chest compression rate, average compression rate, average compression depth, and overall compression in the targeted zone were obtained, meeting all the required criteria to deliver high-quality CPR. Overall survival rate in cancer patients was 79% after CPR efforts. The survival rate at 24h was 48%, while the rate of survival to discharge was 17%. 64% of the patients changed their code status to DNR in critical care settings. Conclusions: The prognosis remains poor for cancer patients undergoing CPR. A significant proportion of patients who survive CPR will become DNR postcode. Physicians should effectively and honestly engage in discussing end of life matters with their cancer patients.
Hospice and hematologic malignancies: Utilization and caregiver perspective.
Authors: Jones Jessica Trevino , Karnad Anand B. , Kakarla Sushanth , Gregorio David , Hung Annie 
Published: November 2018

72 Background: Hematologic malignancies (HM) such as leukemias, lymphomas, and myeloma are potentially curable or may have long lasting remission with current therapy. While therapy may prolong life even in an incurable setting, treatments for relapsed or refractory disease for many hematological malignancies fail and a substantial number of patients with HM are terminally ill. Hospice care services are notably underutilized for HM. Methods: We performed a retrospective cohort analysis of 22 patients treated from 2013-2016 with terminal HM. Using an adapted version of the Burden Scale for Family Caregivers, surviving family members of deceased patients were surveyed for their perspective of hospice care services. Variables examined included date of diagnosis, data of hospice enrollment if applicable, if the patient experienced any resuscitation attempts, if the patient died in hospital, number of days for last hospitalization, and admissions/ER visits within 6 months of death. Results: 11/22 (50%) of patients had AML/ALL; 9/22 (41%) had refractory lymphoma; 1/22 (4.5%) had refractory myeloma; 1/22 (4.5%) could not be included as the patient was subsequently enrolled on clinical trials. Time from diagnosis to death for AML/ALL patients was 306 days; Refractory lymphoma and myeloma patients was 408 days. 8/21 (38%) of patients died in hospital, with 1 resuscitation attempt. For AML/ALL patients, 6/11 (55%) enrolled in hospice at average of 363 days. Once in hospice, average time to death was 25 days. For Refractory lymphoma and myeloma patients, 9/10 (90%) enrolled in hospice at average of 320 days. Once in hospice, average time to death was 70 days. 7/22 (31%) of surviving family were able to be reached to participate in our adapted survey. 4/7 caregivers would not have utilized hospice/palliative care sooner than they did; 2/7 caregivers would have enrolled sooner retrospectively; 1/7 caregivers did not have palliative care/hospice options offered to them. Conclusions: Terminally ill patients face significant barriers to hospice care despite evidence of worsening disease. Realistic expectations and discussions with patient and caregivers need to be addressed in patients with relapsed/refractory HM.
Translation and evaluation of a lung cancer palliative care intervention for community practice.
Authors: Nguyen Huong Q , Martinez Loraine , Mirasol Chrissie , Land Meesha , Borneman Tami R. , Macias Mayra , Ruel Nora , Ferrell Betty R. 
Published: November 2018

77 Background: A notable gap in the evidence-base for outpatient palliative care (PC) for cancer is that most trials were conducted in specialized centers with limited translation and further evaluation in “real-world” settings. Health systems are desperate for guidance on effective, scalable models. The purpose of this study was to determine the effects of a nurse-led PC intervention (PCI) for patients with non-small cell lung cancer (NSCLC) and their family caregivers (FCGs) in a community-based setting. Methods: Two-group, prospective sequential, quasi-experimental design with phase 1 (usual care) followed by phase 2 (intervention) conducted at three Kaiser Permanente Southern California sites. Participants included patients with stage 2 - 4 NSCLC and their FCG. Standard measures of quality of life included FACT-L, FACIT- SP12, City of Hope Family QOL; other outcomes were distress, healthcare utilization, caregiver preparedness and perceived burden. Results: Patients in the intervention cohort had significant immediate improvements in three (physical, emotional, and functional well-being) of the five quality of life (QOL) domains at 1 month that were sustained through 3 months compared to usual care (p < .01). Caregivers in the intervention cohort had improvements in physical (p = .04) and spiritual well-being (p = .03) and preparedness (p = .04) compared to usual care. There were no differences in distress or health care utilization between cohorts. Conclusions: Our findings suggest that a research-based PC intervention can be successfully adapted to community settings to achieve similar, if not better, QOL outcomes for patients and FCGs compared to usual care. Nonetheless, additional modifications to ensure consistent referrals to PC and streamlining routine assessments and patient/FCG education are needed to sustain and disseminate the PCI. Clinical trial information: NCT02243748.
Impact of palliative care interventions on health-related quality of life (HRQOL): A secondary analysis of the Promoting Resilience in Stress Management (PRISM) Randomized Controlled Trial (RCT).
Authors: Steineck Angela , Bradford Miranda , Lau Nancy , Scott Samantha , Yi-Frazier Joyce P. , Rosenberg Abby R. 
Published: November 2018

78 Background: PRISM, a novel intervention for adolescents and young adults (AYAs), seeks to enhance resilience skills via four in-person sessions. Primary analysis of the RCT in AYAs with cancer showed PRISM improved HRQOL. This secondary analysis aimed to explore changes in HRQOL domains and differences between patient groups. Methods: English-speaking AYAs (12 - 25 years) were randomized to PRISM or usual care (UC) from Jan 2015 - Oct 2016. Surveys were completed at enrollment and six months later, using the Pediatric Quality of Life Inventory (PedsQL) Generic Short Form (SF-15) and Cancer Module to assess HRQOL. We compared change scores (PRISM vs UC) by domain (PedsQL SF-15: physical, emotional, social, school; cancer: pain, nausea, procedure anxiety, treatment anxiety, worry, cognition, perceived appearance, and communication). Participants were stratified by age (12 - 17 years vs 18 - 25 years) and advanced cancer status (yes/no). Results: 74 patients (36 PRISM, 38 UC) completed 6-month assessments. 72% were 12 - 17 years old. 23% had advanced cancer at enrollment. PRISM improved patient-reported communication (UC: median [interquartile range, IQR] 0 [-17, 8]; PRISM: 8 [0, 25]). Younger patients seemed to benefit more, especially in PedsQL SF-15 school (12 - 17: UC 0 [-8, 0], PRISM 13 [0, 17]; 18 - 25: UC 0 [-33, 17], PRISM 0 [-25, 17]) and social domains (12 - 17: UC 0 [-33, 0], PRISM 0 [0, 8]; 18 - 25: UC 0 [-25, 4], PRISM -17 [-25, 8]), and cancer-specific perceived appearance (12 - 17: UC -4 [-25, 0], PRISM 8 [-8, 25]; 18-25: UC 0 [-21, 0], PRISM -8 [-25, 17]). Patients with advanced cancer seemed to benefit in cancer-specific domains nausea (no: UC 0 [-10, 15], PRISM 10 [-10, 40]; yes: UC 6 [-15, 25], PRISM 35 [25, 50]) and pain (no: UC 13 [-13, 25], PRISM 6 [-13, 25]; yes: UC -13 [-25, 0], PRISM 6 [-13, 25]). Patients without advanced cancer seemed to benefit in perceived appearance (no: UC -6 [-33, 0], PRISM 0 [-8, 17]; yes: UC 0 [-8, 17], PRISM 4 [-8, 17]). Conclusions: With PRISM, younger AYAs were better able to cope with age appropriate challenges (social, school, appearance) and AYAs with advanced cancer improved physical symptom HRQOL. Clinical trial information: NCT02340884.
Implementation of a rapid access multidisciplinary bone metastases clinic to improve access to care at a large cancer center.
Authors: Colbert Lauren Elizabeth , Gomez Meaghan , Todd Sarah , Tang Chad , Christopherson Kaitlin , Grosshans David R , Lin Lilie L. , Bird Justin E , Moon Bryan , Satcher Robert L , Lewis Valerae O. , Koong Albert , Gomez Daniel Richard 
Published: November 2018

79 Background: MD Anderson Cancer Center is a large cancer center with 44,000 new patients per year. Radiation therapy (RT) is an effective treatment for bone metastases that can reduce pain medication use and improve quality of life. Our goal was to assess the effect of implementing a rapid access multidisciplinary clinic for bone metastases (RABC). Methods: RABC was instituted to schedule patients for radiation oncology and orthopedic surgery consult within 48 hours of referral. Same day simulation and treatment times were held for these patients for one 8Gy fraction. Thirty sequential patients treated with one fraction to bony sites in the outpatient setting prior to implementation of the clinic were chosen as a comparison group. Time from consult order to consult visit (OTV) and from consult visit to treatment completion (CTT) were recorded, in addition to frequency of multidisciplinary care (MDC; orthopedic surgery and radiation oncology). Overall Time (OT) was calculated from referral to treatment completion. T-test and chi-square test were used for analyses. Results: Between April 2018 and July 2018, 72 patients were referred to RABC. 23 patients were seen in consultation and received RT. Sites treated were pelvis (N = 10), spine (N = 6), lower extremity (N = 4) and upper extremity (N = 3). Patients had one site (N = 20), two sites (N = 2) or three sites treated (N = 1). Histologies included breast (N = 5), thoracic (N = 7), gastrointestinal (N = 6), genitourinary (N = 2) and head/neck (N = 2). OTV was shorter for RABC patients (mean 3.3 [+/-5.7] vs. 9.5 days [12.4]; p = 0.02). CTT was also significantly shorter for RABC patients (mean 5.4 hours [+/-1.8] vs. 6.5 days [+/-6.5]; p < .0001). OT was also shorter (3.5 days [+/-5.6] vs. 16.4 days [+/-14.8]; p < .0001). RABC clinic patients were more likely to receive MDC (100% vs 28%; p < .0001). Conclusions: The rapid access bone metastases clinic significantly decreased overall time from consult to completion of treatment and also decreased time to access radiotherapy. Patients were also more likely to receive multidisciplinary evaluation. The RABC approach is a promising model to improve palliation for patients with painful bony metastases.
Interdisciplinary palliative care communication for quality palliative care: Outcomes of a statewide train-the-trainer course.
Authors: Ferrell Betty R. , Buller Haley , Anderson Wendy , Paice Judith A. , Donesky Doranne 
Published: November 2018

83 Background: Expert communication skills are essential for the delivery of effective palliative care across the domains of care. However, few healthcare providers receive formal communication training. The purpose of this presentation is to describe a train-the-trainer course for interprofessional hospital-based palliative care teams to prepare them to teach other healthcare professionals palliative care communication skills. Methods: This project was organized by the eight domains of the National Consensus Project (NCP) guidelines for quality palliative care and provided communication skills training for California-based teams. Funded by the Archstone Foundation, this 2-day train-the-trainer course included skill-building exercises and interactive discussions to assist participants in integrating communication skills-building into their clinical settings. Using a goal-directed method of teaching, the faculty assisted teams in developing three institutional goals for providing palliative care communication training to other healthcare professionals. Evaluation of the course included immediate post-course evaluation and follow-up evaluation at 6 and 9 months. Results: The first statewide interprofessional communication training took place in January 2018 with 26 palliative care teams consisting of primarily nurses, followed by social workers, chaplains and physicians. The 46 course participants’ post-course evaluations demonstrated high satisfaction with the course. On a scale of 1 to 5 (1 = lowest), the course met participants’ expectations and objectives (4.8). The teams’ pre-course goals focused on: 1) staff education, training and mentorship, and 2) institution-wide system changes involving communication with palliative care. Conclusions: A 6 and 9 month follow-up will evaluate team progress on institutional goals (e.g. status and implementation) and provide an update on the additional healthcare professionals trained by course participants and changes implemented within their health system.
Changes in the setting of first consults to palliative and supportive care over a 7-year period.
Authors: Prado Bernard Lobato , Haider Ali , Naqvi Syed M. , Carmagnani Pestana Roberto , Williams Janet L. , Dibaj Seyedeh , Liu Diane D. , Allo Julio A. , De la Cruz Vera J , Bruera Eduardo 
Published: November 2018

86 Background: Optimal benefits from palliative cancer care (PC) are achieved when first consults (PC1) occur early, ideally in the outpatient setting. Late PC1, such as those occurring in the intensive care unit (ICU), limit the benefits of PC and are a poor indicator of the integration of PC and oncology. Our aim was to determine the proportion of PC1 over time in three clinical settings: outpatient clinic (OPC), ICU, and inpatient non-ICU (IP). We also examined patients’ demographic and clinical characteristics and the timing of PC access (from PC1 to death or last contact) by the setting of PC1. Methods: We evaluated consecutive administrative/billing records to ascertain the annual number of PC1 and its distribution across settings from 2011 to 2017. ICU PC1 (n = 309) and a random sample of an equal number of OPC and IP PC1 were reviewed to retrieve patients’ demographics, clinical characteristics, and date of death/last contact. The Cochran-Armitage trend test was used to determine trend differences in the proportion of PC1 among settings. Results: The total annual number of PC1 increased by 58% from 2011 (n = 2286) to 2017 (n = 3615). We found a significant decreasing trend in the proportion of PC1 at the ICU (from 2.3% in 2011 to 1% in 2017, p < 0.001). There were no significant changes over time in the proportion of PC1 at OPC versus inpatient settings (p = 0.2). Hematologic cancer patients were more likely to have a PC1 at the ICU (p < .001). PC1 at ICU accessed PC much later, median survival (95% CI) after PC1 in months: OPC= 7.7 (6.3 - 9.7); IP= 3.4, (2.4 - 4.5), ICU= 0.1 (0.1, 0.1), p < .01). Conclusions: Over time, the total annual number of PC1 has increased and the proportion of PC1 at ICU, a very late clinical setting, is decreasing. Further efforts are needed to promote early PC referrals for patients with hematologic malignancies.