bluuebunny/crossref_metadata_2025_split huggingface dataset:
Correlation of demographic factors with length of treatment and survival in a palliative radiation oncology population.
Authors: Hertan Lauren Michelle , Nichipor Alexandra , Khouj Yaseer Mohammed , Zaslowe-Dude Cierra , Balboni Tracy A. , Krishnan Monica Shalini 
Published: November 2018

123 Background: Radiation is often used to palliate symptoms in patients with advanced cancer and the number of fractions used can vary significantly from as short as a single fraction (SF) to up to a multiple week course. No data currently exists regarding demographic factors and their influence on survival and fractionation decisions. The aim of this project is to investigate the association of demographic factors with survival, likelihood of SF use in patients (pts) receiving RT for bone metastases, and likelihood of hypofractionation (HF) (≤ 5 fx) in pts being treated for any palliative reason, excluding those receiving partial brain RT (PBRT) which includes stereotactic radiosurgery, and stereotactic radiation therapy. Methods: We retrospectively reviewed charts of pts treated with palliative RT between 1/2015 – 5/2017 at 2 tertiary centers and 4 community satellite practices. Demographic factors analyzed are included in table 1. Logistic regression was used to evaluate the associations between the factors and outcomes. Results: A total of 928 pts were included in the survival analysis. In the two subset analyses, 373 pts were included in the bone metastasis analysis and 745 were included in the analysis of all patients excluding pts receiving PBRT. In pts treated for bone metastases, consult type (inpatient vs. outpatient) was the only significant factor on multivariate analysis, with inpatient consults being more likely to get SF (HR = 2.169, =.025). In the pts receiving palliative RT (excluding PBRT), race and consult location (tertiary vs. community) were significant. Non-white pts (HR=0.527, p=.012) and pts treated in the community (HR=.778, p<.001) were less likely to get HF. Gender (male vs. female), consult location (tertiary vs. community), and consult type (inpatient vs. outpatient) were significant on multivariate analysis for survival (HR=1.243, p=.028; HR=1.602, p<.001; HR=2.301, p<.001, respectively). Conclusions: This analysis suggests that demographic factors may affect both survival and decision making regarding fractionation in patients receiving palliative radiation. Further investigation into the reasons for these differences is needed.
Communicating the introduction of psychology services in the palliative care (PC) cancer setting: A randomized double blind trial.
Authors: Ann-Yi Sujin , Tanco Kimberson Cochien , Carmack Cindy L. , Liu Diane D. , Bansal Swati , Williams Janet L. , Lim Kyu-Hyoung , Bruera Eduardo 
Published: November 2018

129 Background: Despite high distress and empirical support for psychosocial services for cancer patients, the utilization of these services continue to be low. Our aims are to ascertain if the manner of introducing psychology services impact patients’ acceptance of services and identify factors associated with acceptance and barriers of psychology utilization. Methods: 100 PC cancer patients who have not received prior psychology services were randomized to observe two video vignettes: one showed a physician introducing a counselor and psychology services to the patient (PI); another showed a counselor entering and introducing psychology services alone (CI). Randomization was stratified using baseline Hospital Anxiety and Depression Scale scores. After viewing both videos, patients completed a survey regarding preference, attitudes, and barriers for psychology services. Patients were blinded regarding the purpose of the study and investigators were blinded to content and order of videos presented. Results: 64 patients reported a preference with 34 preferring PI (p=0.37) and 36 reporting no difference. Younger patients preferred PI (85.7%) versus CI (14.3%, p=0.03). Most reported being aware of available psychology services (N=63), and half (N=50) had been offered psychology services by their physician. Only 40 (40%) patients felt psychology services would be helpful for them, and 43 (43%) reported it would be beneficial for their family/caregivers. Those who found it helpful for themselves or family had higher anxiety than those who did not find it helpful (p=0.03 and p=.02 respectively). The most commonly endorsed barriers for psychology services were travel (N=25) and finances (N=21). Conclusions: We found no significant difference in preference of introduction of psychology services except in patients less than 40 years old who preferred PI. Patients with higher anxiety felt psychology services were helpful for self and family. Only 40% perceived psychology services as useful for self and family. More research is needed to investigate the most effective approach for introducing psychology services to increase perception of usefulness and utilization in cancer patients. Clinical trial information: NCT03035448.
The pyramid of treatment levels: A tool to convey goal-based treatment options.
Authors: Leeper Heather , Kamell Andrew 
Published: November 2018

147 Background: 60% of Americans die in acute care hospitals and under 40% of advanced cancer patients have end-of-life care discussions with their health care providers. Didactic methods and tools to teach about symptom management, navigation of treatment decisions, code status, and end-of-life care decisions within an inpatient setting are a necessity to meet this high demand. Methods: A model of medical care systematically dividing clinical management decisions into escalating levels of medical care relative to illness severity, treatment goals, and code status was created. The model is illustrated as a pyramid with a base of symptom management as the initial level of medical care. The second level represents disease-focused medical care including antibiotics, disease-modifying drugs, and chemotherapy administration. Hospitalization with increasingly complex and invasive interventions represents the third level followed by critical illness care including ICU admission and vasopressors as the fourth level. Intubation comprises the fifth level and CPR forms the top of the pyramid. Results: This model has been used extensively at our institution in educating medical students, residents, fellows, and faculty. All groups reported it was helpful in understanding POLST forms, code status, and collaboratively developing appropriate goal-based care plans with their patients. Symptom management remaining as a non-negotiable foundation of care emphasizes its importance. This depiction of medical care may facilitate goals of care and code status discussions and is particularly helpful for determining appropriate care goals or options when considering de-escalation of medical therapies. Used implicitly or explicitly in patient and family discussions, it has facilitated decision-making and discerning the appropriateness of the overall treatment plan relative to patient goals of care. Conclusions: This model of care with its companion pyramid accommodate a wide range of clinical scenarios, is an effective, high yield didactic device for patients, families, and healthcare providers alike, and has applications as supportive tool to optimize goal-based clinical decision making in the context of serious illness.
Needs for patients with cancer who have young children.
Authors: Kojima Rebekah , Takada Hiromi , Yoshida Tetsuhiko , Shimizu Masaki , Kiuchi Daisuke , Ishiki Hiroto , Satomi Eriko 
Published: November 2018

150 Background: The number of cancer patients has been increasing in Japan. It is estimated that 56,143 parents with 87,017 young children (under 18 years old) are diagnosed with cancer per year in Japan (Inoue, 2015). The aim of this study is to investigate the needs of cancer patients who have young children. Methods: The survey was conducted from February to April 2018 to the cancer patients who have young children treated at the National Cancer Center Hospital with the questionnaires. It was on items about parenting concerns evaluated with the 4-point Likert scale: 1. strongly disagree, 2. slightly disagree, 3. slightly agree, and 4. strongly agree. The items included “cancer notification to their children”, “parental anxieties”, and others. The items were analyzed separately. Results: The respondents were 152 (143 cancer patients (94%) and nine spouses (6%)). Most respondents (92%) agreed the importance of psychosocial support for the children and parents in hospital. The average age of their young children (n = 237) was 9.5 (ages 0 – 17). The result showed that 148 (62%) children were told true parents’ illness. This study also revealed that parents were struggling with the conflict telling their children truth. Most parents wanted to protect children from emotional distresses and were afraid of it or don’t know how to cope with some changes during treatments. Conclusions: The study describes how cancer impacts on parents for child rearing. Almost all of the patients with minor children had been found psychologically distressed. It is necessary to improve an effective psychosocial support system in hospitals for cancer patients with young children based on their needs.
Associations between the patient-physician relationship and health-related quality of life among patients with cancer.
Authors: Mbah Olive , Schaal Jennifer , Cykert Samuel , Eng Eugenia , Robertson Linda , Baker Stephanie , Black Kristin Z. , Dixon Crystal , Ellis Katrina , Elkins Wendi , Guerrab Fatima , Jordan Lauren C , Lightfoot Alexandra , Padilla Neda R. , Samuel Cleo A. 
Published: November 2018

162 Background: Health-related quality of life (HRQOL) is an important cancer care outcome. Patient-physician communication is linked to HRQOL, yet less is known about the role of other aspects of the patient-physician relationship in explaining HRQOL outcomes in cancer patients. Using secondary data from the Accountability for Cancer Care through Undoing Racism and Equity study, we examined associations between multiple patient-physician relationship factors and HRQOL in breast and lung cancer patients. Methods: The analysis included 283 patients receiving care at two cancer centers from 2013-2017. Survey data on socio-demographics, HRQOL, and patient-physician relationship (i.e., doctors’ respectfulness, time spent with doctors, doctors’ involvement of patient in decision-making, satisfaction with quality of care) were collected at baseline and during treatment. The primary outcome was a binary measure of poor-fair (vs. good-excellent) HRQOL 90 days post-diagnosis. We employed multivariate logistic regression to assess associations between patient-physician relationship factors and HRQOL. Results: In adjusted analyses, patients reporting high levels of physician respect had 78% lower odds of reporting poor-fair HRQOL than patients reporting low levels of respect (Adjusted Odds Ratio[AOR] = 0.22; 95%CI = 0.08-0.59). Patients who were optimally involved in their care had lower odds of poor-fair HRQOL than those less involved (AOR = 0.30; 95%CI = 0.12-0.77). Finally, patients who very satisfied with the quality of their care had a 40% lower odds of poor-fair HRQOL than those less satisfied with care (AOR = 0.40; 95% CI = 0.13-0.99). There was no association between amount of time spent with doctor and HRQOL. Conclusions: Multiple aspects of the patient-physician relationship, including doctor’s respectfulness, doctors’ involvement of patient in decision-making, and patient satisfaction with quality of care are associated with HRQOL among breast and lung cancer patients. Given the important role that HRQOL plays in treatment adherence and outcomes, these findings highlight the need for systems of care that optimize the physician-patient relationship in cancer care.
Health after cancer: Early patient experience in a pilot survivorship clinic embedded in primary care.
Authors: Schapira Lidia , Winget Marcy , WU Siqi , Kim Jennifer , Brown-Johnson Cati 
Published: November 2018

180 Background: Prior research has identified barriers to provision of quality survivorship care in primary care settings such as lack of expert knowledge and training, primary care burden and insufficient communication with oncologists. We implemented a survivorship clinic at an academic medical center in the primary care division with the goal of defining the elements required for a seamless transition and co-management. Methods: The primary care physician received training in cancer survivorship based on the ASCO Curriculum, shadowing of 3 breast medical oncologists and 1 gynecologic oncologist, attendance at the 2018 Cancer Survivorship Symposium and NCCN’s Cancer Survivorship Advocacy Meeting. Patients with breast and gynecologic cancers were referred by their oncologists or APP (PA or NP) at various points in their cancer trajectory. Clinical characteristics of patients were abstracted from the electronic medical record and in-depth interviews were conducted with 2 patients. Results: 41 patients attended the survivorship clinic. The majority (88%) were breast (63%) or gynecologic (24%) cancer survivors. Patient age was evenly distributed with 8 age < 46, 11 age 46-59, and 7 age > = 60. 23 (56%) patients had stage < 3 at diagnosis. 21 (51%) had been cancer-free for five years + and 4 were referred by their oncologist to help with patient co-management during cancer treatment. Of the 8 breast cancer patients < 46 years old, 6 had a genetic mutation and 7 were interested in fertility. 15/26 breast cancer patients are currently on endocrine therapy. Interviewed patients expressed appreciation for receiving whole-person care and knowing there is bidirectional communication between clinicians. Conclusions: Cancer survivors are open to and interested in a survivorship visit based in a primary care clinic; this includes both patients who have been cancer-free > 5 years as well as those recently treated with curative intent. Greater efforts are needed to train primary care physicians to deliver survivorship visits that are customized to meet the needs of cancer survivors.
Multimodal therapy for the treatment of sleep disturbance in patients with advanced cancer.
Authors: Yennu Sriram J. , Carmack Cindy L. , Balachandran Dave , Williams Janet L. , Lu Zhanni , Park Minjeong , Hess Kenneth R. , Ochoa Jewel , Bruera Eduardo 
Published: November 2018

185 Background: Poor sleep quality is frequent in patients with advanced cancer (62%), and is associated with a severe symptom distress and mortality. There are limited evidence based treatment options in advanced cancer patients.To obtain feasibility, preliminary estimates of the effects of various treatments [light therapy, melatonin, Methylphenidate] and combinations of treatments in multimodal therapy (MMT) to improve sleep quality, as measured by change in Pittsburg Sleep Quality Index (PSQI) scores from baseline to Day 15. We also examined MMT effects on FACT-G, insomnia - Insomnia severity index (ISI), actigraphy. Methods: Cancer patients with moderate sleep disturbance were eligible. Using a double-blind (patient, investigators) randomized factorial study design, eligible Pts were randomized into 1 of the 8 arms of the study which included all possible combinations of the interventions (light therapy, melatonin, and methylphenidate) and/or their corresponding placebo treatments for a duration of 2 weeks. All patients received 3 sessions of standardized CBT. Linear regression analysis was used to assess treatment effects. Results: 84% (54/ 64) randomized Pts were evaluable. At baseline, median (IQR) total PSQI was 13 (12, 15); and ISI was 18 (14, 21). There were no differences in the demographics and baseline sleep quality between groups. The adherence rates for light therapy, melatonin, and methylphenidate were 93%, 100%, and 100% respectively. Light therapy had moderate effects on sleep quality (effect size .43, P=0.017). No significant differences in ISI, FACT-G scores, and objective sleep variables between groups. There were no significant difference in adverse events by groups (P=.97). Conclusions: MMT interventions to treat sleep disturbance were feasible. Light therapy provided the best signal for improvement in sleep quality, and should proceed to large randomized control trials. Clinical trial information: NCT0168029. [Table: see text]
Total relaxation: A Buddhist mindfulness-based intervention pilot studies in laypersons and cancer patients.
Authors: Suwanvecho Suthida , Suwanvecho Buntharika , Pongpirul Krit 
Published: November 2018

187 Background: Total relaxation (TR), a mindfulness-based intervention based on the Buddha’s teaching of Sutra on Full Awareness of Breathing (Anapanasati Sutta) and Sutra on the Four Establishments of Mindfulness (Satipatthana Sutta). This study was aimed (1) to explore benefits of TR perceived by laypersons and (2) to share experience in piloting the intervention in cancer patients. Methods: Laypersons who attended the 5 - day retreat program with daily TR sessions at Khao Yai, Nakhon Ratchasima, Thailand during October 22-26, 2014 responded to the Edmonton Symptom Assessment Scale (ESAS) before and after the TR session on the first day (TR1 Before, TR1 After) and after the fourth TR session (TR4 After). ESAS was responded by cancer patients who visited Horizon Cancer Center, Bumrungrad International Hospital before and after their participation in a 45 minute TR group session. Paired t-test was used to evaluate the before-after difference in score of each matched variables. Results: Of 162 laypersons, 90.74% responded. They reported a significant improvement of all ESAS items (p < 0.001). Ten cancer patients (6 breast, 2 colon, and 1 stomach cancers and 1 lymphoma) who participated in the TR group session also saw the improvement of all ESAS items, with the mean differences ranging from 0.36 (feeling depressed) to 3.09 points (fatigue/tiredness). No adverse events were observed. Conclusions: Total relaxation is a Buddhist mindfulness-based technique that can improve undesirable symptoms of layperson and cancer patients.
A comparison of the attitudes about the legalization of marijuana use for medical purposes by cancer patients in two cancer centers located in a legalized and a non-legalized state.
Authors: Tanco Kimberson Cochien , Dumlao Donato , Kreis Rebecca Rae , Nguyen Kristy , Dibaj Seyedeh , Liu Diane D. , Marupakula Vidyasagargoud , Shaikh Ayesha , Williams Janet L. , Cantu Hilda P. , Jones Marie , Beers Wendy , McMahon Michael , Allo Julio A. , Noggy Brenda , Baile Walter F. , Bruera Eduardo 
Published: November 2018

191 Background: There is limited evidence on the perception of medical marijuana (MM) among cancer patients in a legalized vs. a non-legalized state. In this study, we compared the attitudes of cancer patients in a legalized (Arizona) vs. a non-legalized state (Texas) on legalizing marijuana for medical use and their perception of its medical usefulness. We also examined their preference of MM for pain, anxiety and depression against current treatments and examined any demographic, physical or psychosocial association with its perception. Methods: Two hundred adult cancer patients were enrolled from the outpatient palliative care centers at Banner MD Anderson Cancer Center in Gilbert, AZ and The University of Texas MD Anderson Cancer Center in Houston, TX. All patients were residents of the state where they were enrolled. Various physical and psychosocial instruments were collected including a survey designed to determine attitudes and beliefs of patient towards MM. Due to the sensitivity of information, no identifiers were associated with data recorded. Results: No significant difference was found between both locations in attitude towards legalizing MM [Arizona 92% (85 - 97%) vs. Texas 90% (82 - 95%); p = 0.81] and belief of its usefulness [Arizona 97% (92 - 99%) vs. Texas 93% (86 - 97%); p = 0.33]. Patients preferred MM over current treatments for anxiety [60% (51 – 68%); p = 0.003] but not for pain and depression. Patients who favored legalizing MM were younger (median age 59 vs. 67 y; p = 0.027) and had worse Edmonton Symptom Assessment System fatigue (median 5 vs 3; p = 0.015) and appetite (median 3 vs 0.5; p = 0.004) scores. There was a significant difference among those who have used MM (95%) and have not used MM (88%) in support of legalization of MM (p = 0.024). Conclusions: Cancer patients from both legalized and non-legalized states showed strong support for legalization of marijuana for medical purposes and strong belief in its medical use. Patient who are younger, and had worse fatigue and appetite showed higher support for medical marijuana.
Patient-reported outcomes with metastatic castrate-resistant prostate cancer.
Authors: Mullally Jimmy , Davella Christopher , Parikh Rahul Atul , Van Londen G J. , Appleman Leonard Joseph 
Published: November 2018

207 Background: Prostate cancer accounts for approximately 10% of cancer deaths in men worldwide. Clinical trials for metastatic castrate resistant prostate cancer (mCRPC) have established survival benefit with use of abiraterone (ABI) with prednisone or enzalutamide (ENZ). Despite their wide utilization, little is known about patient quality-of-life (QOL) outcomes for these agents. Our study evaluates patient reported QOL while taking ENZ or ABI/prednisone. Methods: 22 mCRPC patients were enrolled in an open label, nonrandomized manner to receive oral ENZ (n=12) or ABI/prednisone (n=6) per oncologist’s discretion. Patients completed multiple QOL validated questionnaires, including EPIC-26, FACT-P, and FACT-COG at baseline, 1,2,3,6,9 and 12 months or until progression/change of therapy. Surveys were scored by treatment group using mean, median, range, and standard deviations. QOL parameters were compared between the two groups with two-sided, two-sample T test and linear mixed models. Results: Surveys discontinued prior to 1 year secondary to disease progression/change of therapy were 58% and 33% for ENZ and ABI, respectively. By month 3, 50% of surveys were returned for ENZ and 33% for ABI. Month-to-month comparisons of QOL parameters including urinary irritation, incontinence, bowel, sexual, hormonal function, and overall well-being showed no significant differences between treatment groups or different rates of change. Perceived Cognitive Impairment was significantly lower for patients on ABI in month 3, yet Perceived Cognitive Ability favored ENZ in months 2 and 3. All other data points for cognition showed no significant differences. Conclusions: Data from FACT-COG shows discordance in perceived Cognitive Impairment and Abilities between ENZ and ABI in months 2-3. Other QOL domains indicated no difference between the two groups. The study was limited by a significant portion of patients with disease progression/change of therapy. For those on therapy, survey compliance remained high. Thus, the use of questionnaires is a feasible means of assessing patient outcomes and can be adapted to larger studies.