bluuebunny/crossref_metadata_2025_split huggingface dataset:
Chemical coping and efficacy of buprenorphine for cancer pain.
Authors: Case Amy Allen , Hansen Eric , Nadagoundla Chitra , Wang Chong 
Published: November 2018

200 Background: The management of cancer-related pain is challenging in the age of the opioid epidemic. Patients who struggle with substance misuse or chemical coping use these substances to dull emotional and or existential suffering. Buprenorphine is often used for cancer pain due to less reported euphoria when compared to other opioids. Methods: We conducted a retrospective review of patients in an outpatient palliative care clinic at a tertiary comprehensive cancer center who were prescribed buprenorphine for cancer pain. Total oral morphine equivalent (OME), as well as use of adjuvant non-opioid neuropathic pain medication, were assessed prior to transition to buprenorphine. Chemical coping behavior was defined as patients taking opioids for emotional pain in excess of the maximum prescribed amount. Pain scores were reported before and after buprenorphine administration using a Likert pain scale (0-10). Patients were also assessed for the presence of withdrawal symptoms after transition to buprenorphine. Results: Patients were predominantly female (75%), slightly more than half had a psychiatric diagnosis (56%), a majority were on non-opioid neuropathic pain medication (93%), and the majority were identified as chemical copers (75%). For all patients, the mean pain score prior to buprenorphine (pain pre) was 8.3 and the mean pain score on follow up post buprenorphine (pain post) was 6.1, with a reduction in mean pain score (pain change) of -2.0 (p = 0.059). Patients without chemical coping behaviors reported a significantly greater reduction in pain scores compared to patients with chemical coping (pain change -5.0 vs -1.3, p = 0.02). Illicit drug use and psychiatric co-morbidity were not associated with differences in reported pain scores. Only a small number of patients reported withdrawal symptoms (6%) during buprenorphine transition. Conclusions: Rotation to buprenorphine led to a trend of reduction in pain score, though not statistically significant. Patients without chemical coping experienced greater reductions in pain score than those with chemical coping behavior. Illicit drug use and psychiatric co-morbidity were not associated with differences in reported pain.
The rate and treatment outcome of thiamine deficiency in cancer patients diagnosed with delirium: A preliminary study.
Authors: Onishi Hideki , Ishida Mayumi , Uchida Nozomu , Sato Izumi , Takahashi Takao 
Published: November 2018

205 Background: Vitamin B1 is essential for life, but cannot be synthesized in vivo and must be ingested from outside the body. Retention in the body is as short as 18 days, so that long-term appetite loss can easily lead to vitamin B1 deficiency, resulting in a condition known as Wernicke's encephalopathy (WE), which is characterized by disturbed consciousness, ataxia, and ocular movement disorders. Early detection and treatment with intravenous vitamin B1 usually results in recovery without sequelae, while a delay in detection can lead to severe brain damage (Korsakoff syndrome). The mortality rate is approximately 20%. Recent studies have shown that cancer patients may also experience thiamine deficiency and WE. WE is often overlooked as the typical symptoms are nonspecific, and some cases do not exhibit the disturbed consciousness characteristic of WE. Clinical awareness can be improved by confirming the actual rate and clarifying the associated symptoms, leading to more accurate WE diagnosis. Methods: We retrospectively examined the medical records for patients admitted to Saitama Medical University International Medical Center between 1 October 2014 and 31 May 2018 with cancer as the main disease who consulted the Psycho-oncology Department and were diagnosed with delirium by a psychiatrist. Patient background, medical treatment, neurological symptoms, blood biochemical findings, and disease course after vitamin B1 administration were examined. This study was approved by the IRB of this institution (Approval No. 18-080). Results: Eligibility criteria were met by 76 of 126 patients who received consultations during the study period, with 32 (43%) having a vitamin B1 deficiency. Vitamin B1 treatment led to a full recovery in 19 (59%) of these 32 patients. Conclusions: Our results show that the rate vitamin B1 deficiency in patients in this study was high, although >50% of the affected patients recovered with treatment. This indicated that it is necessary to pay close attention to vitamin B1 deficiency in cancer patients with psychiatric symptoms, and future study is planned to clarify the factors involved in the onset of vitamin B1 deficiency.
Pre- and post-comprehensive geriatric assessment in older patients with hematological malignancy before allogeneic stem cell transplantation.
Authors: Haggstrom Daniel Ernest , Figueroa-Sierra Marielys , Knight Thomas Gregory , Induru Raghava , DeRhodes Kim , Edeker Joanna , Cooper Markecia , Caprio Anthony 
Published: November 2018

212 Background: Comprehensive geriatric assessment (CGA) is a multi-dimensional evaluation which influences medical decisions and predicts toxicity in older cancer patients. CGA pre-allogeneic stem cell transplant patients (ASCT) and repeated post-transplant provides information about treatment and helps to determine which parameters may predict ASCT outcomes. Methods: This was a prospective observational study evaluating 17 older patients with hematologic malignancy with CGA between December 9, 2016 and April 3, 2018 within the Levine Cancer Institute Senior Oncology Clinic. Included were validated measures across domains of cognition, disability, frailty, function and psychologic status. Repeat CGA was performed on surviving patients at least 99 days after ASCT (avg 122 days). Results: Median age was 66 (range 60-75) and the most common diagnosis was AML. There was no notable difference in pre and post-CGA physical and neurocognitive parameters for ASCT survivors (n=8). Within the deceased group (n=9) there was a longer TUG, lower patient-reported KPS, poorer psychological status, grip strength, and social support. Conclusions: There was no notable difference in the physical and neurocognitive CGA parameters before and after ASCT. Although the sample is small, there were notable trends toward lower patient-rated KPS compared to physician-rated KPS, poorer ADL function, slower TUG, and weaker grip strength in those patients who did not survive. CGA may identify older patients with hematologic malignancy who are at risk for worse outcomes post-ASCT.[Table: see text]
Discontinuation of adjuvant sunitinib due to adverse events in patients with high-risk renal cell carcinoma after nephrectomy: A combined analysis of phase III trials.
Authors: Ball Somedeb , Thein Kyaw Zin , Quirch Miguel , Adhikari Nimesh , D'Cunha Nicholas C. , Jones Catherine , Hardwicke Fred L. , Awasthi Sanjay , Tijani Lukman 
Published: November 2018

215 Background: Dysregulation in the vascular endothelial growth factor (VEGF) pathway has been implicated in the pathogenesis of renal cell carcinoma (RCC). Sunitinib is an oral VEGF receptor tyrosine kinase inhibitor and has been approved in the adjuvant treatment of high-risk RCC. However, there are significant adverse events, impacting patients’ quality of life, and leading to treatment discontinuation. We performed a systematic review and meta-analysis of randomized controlled trials (RCT) to determine the risk of high-grade toxicities and the rate of treatment discontinuation due to adverse events. Methods: We conducted a comprehensive literature search using MEDLINE, EMBASE databases and meeting abstracts from inception through June 2018. Phase III RCTs which utilized adjuvant sunitinib in high risk RCC after nephrectomy and mentioned treatment interruption or discontinuation or dose reduction due to adverse events were included. Mantel-Haenszel (MH) method was used to calculate the estimated pooled risk ratio (RR) with 95% confidence interval (CI). Fixed effects model was applied. Results: Two phase III RCTs with a total of 1866 patients were eligible. Studies utilized sunitinib versus placebo. The randomization ratio was 1:1 in both ASSURE and S-TRAC studies. The incidence of high-grade adverse events was 568 (60.5%) in sunitinib group versus 183 (19.6%) in placebo arm, with the relative risk of 3.10 (95% CI: 2.69 – 15.93, P < 0.001). The reduction in dose was reported in 541 (57.9%) in study arm versus 86 (9.2%) in placebo group. The pooled RR for dose reduction was statistically significant at 6.28 (95% CI: 5.10 – 7.74, P < 0.001). The treatment discontinuation rate was 27.9% higher with sunitinib than with placebo (RR - 4.14; 95% CI: 3.31 – 5.16, P < 0.001). Conclusions: Our meta-analysis demonstrated that the rate of dose reduction, treatment discontinuation and the risk of grade 3 and 4 adverse events were notably high in sunitinib group. Timely recognition and proper supportive care are entailed in minimizing those adverse events which may ultimately improve patients’ quality of life and overall compliance.
The stability and variations in the reporting of the CAGE-AID screening questionnaire in cancer patients.
Authors: Edwards Tonya , Arthur Joseph Anthony , Joshi Neeraj , Kuriakose Leela , Joy Manju P , Dibaj Seyedeh , Zhukovsky Donna S. 
Published: November 2018

224 Background: The CAGE-AID questionnaire (CA) is a 4-item patient reported validated screening tool has been used to assess risk of aberrant drug related behaviors in cancer patients receiving opioids. Consistency of responses to the CA between settings is lacking. We evaluated the frequency of CA positivity in each setting and change in score (+ or -) between the first inpatient supportive care consultation and the first outpatient follow up visit within 3 months. Methods: A retrospective chart review was conducted to ascertain CA scores and clinical and demographic characteristics of consecutive adult patients who were initially seen during inpatient consultation (T1) and had an outpatient follow up within 3 months (T2). CA positivity was defined as a score of ≥2 in males or ≥1 in females, with score at T2 considered the gold standard. Results: ±SD) was 122 mg (150) at T2. CA was completed for 87% of T1 patients and 94% at T2. Scores are noted below. Hispanics (23%) were more likely to be CA positive as compared with Caucasians (15%) and African Americans (11%), p= 0.02. Between T1 and T2, CA score changed from negative to positive in 4% and positive to negative in 1% of patients. The Kappa coefficient for agreement of CA between T1 and T2 was 0.74 (0.62, 0.86), p= 0.02. Conclusions: The rate of completion and consistency of patient responses to the CA was high irrespective of clinical setting. Between 10-13% of patients with advanced cancer are at increased risk for aberrant opioid use. Further studies are needed to evaluate the reasons for a change in CA scores between T1 to T2 in some patients so as not to miss those at higher risk for aberrant behaviors in need of additional monitoring and support. [Table: see text]
Spiritual pain and care needs of elderly cancer patients facing palliative chemotherapy decision-making: Qualitative study.
Authors: Tsuboi Rie , Sugishita Mihoko , Hirakawa Hirohisa , Ando Yuichi 
Published: November 2018

25 Background: Although the number of elderly cancer patients who require chemotherapy has increased, few studies have investigated the process of palliative chemotherapy decision-making and care needs of elderly patients with advanced cancer. Methods: The study was conducted at Nagoya University Hospital in Japan from April to October 2017. Face-to-face interviews were conducted with patients over 70 with advanced cancer (n = 15, median age = 77 years, range 70 - 82) who made decisions of palliative chemotherapy initiation within 6 months. Patients’ families and physicians were also interviewed individually. Interview transcripts were qualitatively analyzed using a deductive-inductive approach. Results: Four main themes emerged: physician’s awareness of paternalism, training of communication about serious news, spiritual-care needs assessment, and support with the team. Both the patients and the physicians felt the necessity for physicians’ paternalism in patients’ decision-making. The physicians found treatment decision-making for elderly patients difficult because of the patients’ diversities. Patients had spiritual pains from the time of diagnosis and they continued throughout treatment periods. They fought the illness with the support of surroundings as a team. Conclusions: Paternalism was emphasized from both elderly patients and physicians in palliative chemotherapy decision-making. Improvement of the communication skills of physicians was needed. Patients had spiritual-care needs beginning with the early phase of the treatments and fought as a team with their supporters, including physicians against the cancer. Physicians should be aware of that and be actively involved in whole-patient care.
Stakeholders' perceptions and information needs regarding research medical donation (RMD).
Authors: Epstein Andrew S. , Shuk Elyse , Romano Danielle R. , Lynch Kathleen , Genoff Margaux , Khan Erva , Iacobuzio-Donahue Christine A , Hamilton Jada G. 
Published: November 2018

27 Background: Issues pertinent to serious illness are more prevalent in the current medical landscape of increasing technologic sophistication. RMD, the process of human tissue extraction within hours after death benefits cancer research but data are limited regarding barriers institutions face in accruing to RMD programs. Such data are needed due to the complex RMD process, such as communicating with patients (pts) and their proxies, and procuring tissue in a timely manner that also respects end-of-life care sensitivities. Methods: We explored perceived core needs and challenges of RMD by engaging stakeholders (cancer clinicians, pts, and their caregivers) in 8 teleconference focus groups from 2017-2018. Clinicians caring for pts with breast, pancreas, and lung cancers comprised 2 groups. Each cancer separately had 2 groups for pts and their caregivers. Each group lasted 90 minutes, was audio-recorded and transcribed. Research team members (2-3) recorded their observations about key themes from each transcript in an analysis template, with illustrative quotes supporting each theme. Following independent analysis, the coding team met to reach consensus on primary themes for that transcript. A consensus template describing the team’s views about themes from the transcript was generated. The team then met to establish agreement on the consensus templates and identify primary common and divergent themes across transcripts. Results: 45 people (13 clinicians, 24 pts, and 8 caregivers) participated in the groups. The themes identified were: 1) clinicians and pts generally had limited to no previous knowledge about RMD; 2) RMD was seen to mainly benefit research, not pts or families; 3) logistical and privacy questions and concerns arose; 4) introducing RMD was deemed sensitive and the timing patient-specific; 5) cancer type did not generally seem to impact RMD acceptability or participation. Conclusions: Patients, families, and cancer clinicians have generally low knowledge of RMD but upon learning about it, see it as a valuable program for scientific advancement, necessary to be carried out with individualized sensitivity to end-of-life issues, and through training programs with involved clinical staff.
The perspective of a breast cancer patient: A survey study assessing needs and expectations.
Authors: Sardar Muhammad , Shaikh Nasreen , Danish Mary , Sharon David Julius , Goldberg Dr. Shira 
Published: November 2018

32 Background: Patient satisfaction is one of the key indicators of health care quality. We aim to identify patients’ needs and expectations in a breast cancer clinic to provide a patient-centered care and better overall satisfaction. Methods: A 17-item survey was administered to 49 patients at a breast cancer clinic. The survey was designed after a thorough literature review and approved by an oncologist and a palliative care physician. Results: Self-reported knowledge about disease was reported adequate by 95.9% of our patients yet only 46.9% of our patients could identify the stage of their cancer. More education was desired by 39% of patients including various treatment options (35%), common complications (29%), prognosis (22%) and risk factors (14%). Cancer-related emotional stress and physical symptoms were reported by 53% of our patients. Social/professional life was affected by cancer in 49% of the patients. Majority of our patients (57%) wanted their oncologist to address social/emotional issues and 28% felt the need of more focus on physical symptoms in their subsequent visits. End-of-life care (EoLC) discussions were considered an integral component of overall care by 22% of our patients. Components of EoLC discussions that patients stated they could benefit from included prognosis (24.5%), life expectancy (24.5%), treatment effect on quality of life (20.4%), palliative care (10.2%), hospice (10.2%), advance directives (14.3%), and family involvement in medical decision-making (12.2%). More patients wanted to initiate EoLC discussions when they requested it (30.6%) or their oncologist thought it was appropriate (30.6%) as compared to when it may change treatment course (12.2%) or at diagnosis (8.2%). More patients wanted to have EoLC discussions only once (40.8%) as compared to at regular intervals (32.7%). Conclusions: A discrepancy between self-reported and actual knowledge in breast cancer patients emphasizes the need of patient education. Most patients rely on their oncologist for their diagnosis related emotional and social issues. Surprisingly, a quarter of our patients consider EoLC discussions important even though majority of our patients were healthy and having stage I disease.
Incorporating geriatric patient reported outcomes into novel screening tool of distress and supportive care concerns.
Authors: Gerhart James I , Gordon Ana , Roggenkamp Betty , Khosla Paramjeet , Trosman Julia Rachel , Martin Joanna , Scheu Amy , Wiebe Lauren Allison , Berardi Rosa , Chow Selina Lai-ming , Pasquinelli Mary , Feldman Lawrence Eric , Dale William , O'Mahony Sean , Mumby Patricia B. , Deamant Catherine , Weldon Christine B. 
Published: November 2018

37 Background: The Institute of Medicine (IOM) 2013 Report recommends that supportive oncology care start at cancer diagnosis; the Commission on Cancer (CoC) Standard 3.2 requires distress screening and indicated action. The Supportive Oncology Collaborative, collaborative of 100+ clinicians funded by The Coleman Foundation, developed a patient-centric screening tool (CSOC-ST) adapted from ASCO Distress, NCCN Distress Problem List, IOM report and CoC standards, and other validated sub-tools (Weldon, ASCO-Q 2017). The Collaborative then revised the CSOC-ST tool to align with geriatric guidelines. Methods: Literature and guidelines review of geriatric screening, added items to CSOC-ST, and piloted at 4 sites. Descriptive statistics and Fisher’s exact test used. Results: 473 patients screened with added geriatric relevant items to CSOC-ST: self-care concerns (PROMIS Instrumental Support), living alone (ASCO Distress 2014), and memory / cognition (PROMIS item bank). Treatment/care concern items were revised to identify health care power of attorney and advance directive interest. Geriatric related items endorsed by patients, see Table. PHQ4, Anxiety and Depression, average score 2.4 (mild > 3). Higher scores on the PHQ-4 were significantly associated with each of the following: self-care concerns, memory/cognition concerns and specific treatment/care concerns (p < .0001). Conclusions: Pilot results and comparison to geriatric guidelines identified important items to support geriatric patient reported outcomes screening. After pilot, added 3 items for falls/frailty. Eight sites implementing this CSOC-ST.[Table: see text]
Diagnostic and prognostic awareness among patients with metastatic solid cancer in a public cancer center in Mexico.
Authors: Alcalde Castro Mirza , Chavarri Guerra Yanin , Ramos-Lopez Wendy Alicia , Covarrubias-Gómez Alfredo , Sanchez Sofia , Quiroz Paulina , Navarro-Lara Africa , Medina-Campos Andrea , Moreno-García María Luisa , Contreras-Garduño Sergio , Pérez-Montessoro Viridiana , Goss Paul E. , Soto Perez De Celis Enrique 
Published: November 2018

42 Background: Patient awareness regarding diagnosis and prognosis may lead to improved treatment shared decision making and improve satisfaction with treatment choices. We assessed the diagnostic and prognostic awareness among newly diagnosed patients with metastatic solid tumors in a public cancer center in Mexico City. Methods: Patients with metastatic cancer enrolled in a randomized clinical trial of patient navigation to improve access to supportive care in a public cancer center in Mexico City (NCT03293849) were included. At baseline, demographic, social, and clinical characteristics were collected. Patients answered open-ended questions regarding knowledge about their diagnosis and prognosis, as well as on patient-physician communication. We analyzed prognostic and diagnostic awareness using descriptive statistics, and explored if patients reporting worse patient-physician communication were less aware of their diagnosis and prognosis. Results: 125 patients were included between 08/17 and 04/18. Median age was 61 years (range 23-93; 52% male); 88.8% lived in urban areas; 41.6% had less than high school education; and 57.6% were married or partnered. 61% had gastrointestinal, 14% genitourinary, and 25% other tumors. Although all patients had had at least one consultation with an oncologist, 3% did not know what their diagnosis was. 77% of patients considered they had prognostic awareness; however, only 14% considered that their disease had a bad prognosis, and 2% considered they could be cured. 6.5% of the patients believed the information given by their oncologist was insufficient, and 8% felt they had trouble getting information about their disease. We found no statistically significant relationship between perceived barriers to patient-physician communication and diagnostic (p = 0.28) or prognostic (p = 0.18) awareness. Conclusions: Although most patients understood their oncologic diagnosis, a significant proportion were unaware of their prognosis. Communication strategies, tailored to the specific characteristics of each patient population and aimed at improving prognostic awareness, are fundamental for optimal shared decision making.