bluuebunny/crossref_metadata_2025_split huggingface dataset:
Knowledge, attitude and practice in cancer pain management: A survey study among attending physicians, residents and nurses.
Authors: Ning Ying , Ackula Haritha , Jindal Vishal , Li Mu , Li Pengyang , Siddiqui Ahmad Daniyal 
Published: May 2019

e18278 Background: Our study used KAP model to evaluate differences of Knowledge, Attitude, and Practice regarding cancer pain management among care providers in a community teaching hospital. Methods: A 32-question KAP survey was designed with 3 demographic, 15 Knowledge, 9 Attitude and 5 Practice questions. It was administered randomly and anonymously to attending physicians of medicine, medical residents and medical nurses. 106 effective questionnaires (24 attending, 41 residents and 41 nurses) were analyzed and compared with percentage by Chi-Squared Test using SPSS 25. Results: Majority of all 3 groups believe only 50-60% of cancer pain can be effectively managed, while the actual effectiveness is close to 90% with proper management. Demographically, female predominates in nurses as expected, there is no statistical difference in previous pain/palliative education. Years of experience vary considerably (P < 0.001). Attending perform best in Knowledge (60% correctness), but not statistically better (P = 0.361), a common area of weakness is low awareness of alternative management besides medication. Attending and nurses have more positive attitude compared to residents (P = 0.002). Nurses perform best in Practice mainly demonstrated by higher awareness and consistency in pain evaluation and documentation (P < 0.001). Finally, overall performance is consistent with self-reported confidence. Conclusions: Knowledge is relatively easy to acquire since residents have comparable level to attending, although further education is indicated for all the providers. More care experience and a positive attitude better predicts practice performance. All 3 group seems to lack belief and confidence in effective cancer pain management, another area to be addressed for quality improvement. [Table: see text]
Are the nonmedical needs of cancer patients satisfied adequately.
Authors: Rucinska Monika , Osowiecka Karolina , Sroda Radoslaw , Saied Arian , Milobedzka Magdalena , Miloszewski Jakub , Korzeniewicz Martyna , Oraczewski Rafal , Szwiec Marek , Mangold Sarah , Paszkowska Elzbieta , Osuch Dominika , Nawrocki Sergiusz 
Published: May 2019

e18283 Background: Cancer is a global health care problem. Cancer disease is not only medical problem, there are a lot of areas in human life that cancer has influence on. The rationale for this study was to identified non-medical needs among cancer patients during treatment and assessment of who helps patients. Methods: The study was carried out on a group of 346 patients who were being treated for malignant neoplasm in five oncological centers in Poland. A questionnaire was prepared specifically for this study and each patient was interviewed individually. The questionnaire was validated on a group of 20 patients. The study protocol was approved by the Local Ethics Committee of the University of Warmia and Mazury in Olsztyn, Poland. All of the participants had submitted a signed consent form. Results: There were analyzed 164 women and 180 men (2 no date), median age 65 years. 79% of patients could have hoped for psychological support, most of them received psychological support from partner/family (88%) and friends (31%), less from psychologist (28%) and priest (5%). Half of patients (52%) had a need for social support, 42% of them received social support from partner/family, 12% from friends and only 7% from a social worker. One third of patients (30%) received support from a dietician. The help from a physiotherapist were given to 20% of patients. In the analysis of different factors it was noticed that women more often than men got help from psychologist and physiotherapist (p < 0.05). Some of patients (16%) did not know that they could get help in their non-medical needs. 80% of analyzed patients thought they need someone who would help them with the non-medical problems during their cancer disease. Conclusions: Cancer patients have some non-medical needs, but only a small part of them receives professional support. The proper solution could be a special person who may notice patients problems and coordinate professional support.
Analysis of a neurosurgical directed acute spinal cord compression pathway at Michigan Medicine, a tertiary referral hospital.
Authors: Krauss John C. , Klarr Daniel 
Published: May 2019

e18285 Background: Spinal cord compression (SCC) is considered an oncologic emergency that is likely to severely impair patients’ quality of life if immediate action is not taken. Clinicians need a high suspicion to diagnose SCC, as the presenting symptoms are variable and nonspecific. To expedite the diagnosis and treatment of SCC, we instituted an emergent spine MRI imaging pathway that was led by the neurosurgeons and involved close collaboration with medical oncology and radiation oncology. Methods: The charts of all patients from July 2015 to June 2018 who underwent the “MR Spine Cord Compression Acute” imaging pathway at Michigan Medicine were reviewed. Electronic time stamps provided the time of the initial order, the time to scan completion, the time to scan reading, and the time to definitive intervention. The charts were reviewed for the initial neurosurgical physical exam, a presentation consistent with recent trauma, a previous diagnosis of malignancy, and a previous diagnosis of bone metastases. The type and timing of therapy, and survival following the imaging protocol were assessed. Results: 319 unique MRI exams were done over the three-year span, 155 of the patients had cancer, and 75 patients had SCC. The time from ordering of exam to performance is 2.91 hours (0 to 25.45), from performance to read 8.31 hours (0 to 75.25 hours). Time from MRI to intervention was 63.14 hours (0 to 432 hours) based on complex decision making around surgical vs. radiation vs. medical therapy. For the majority of patients who were diagnosed with SCC, the cause was secondary to tumor growth from contiguous spinal metastasis, and most had previously identified bone metastases. Degenerative disc extrusion was the most common cause of benign SCC. Conclusions: A neurosurgical directed standard imaging protocol is effective at rapidly diagnosing SCC. Malignant SCC is predominately treated surgically, but complex multi-disciplinary patient centered decision-making involving neurosurgery, radiation oncology, and medical oncology is frequently necessary to arrive at the appropriate treatment.
Swallow screen and test in cancer patients.
Authors: Shrotriya Shiva , Abro Calvin , Rous Fawzi Abu , Trimmer Rosemary , Sharma Mukta , Rayamajhi Supratik , Estfan Bassam N. , Walsh Declan 
Published: May 2019

e18288 Background: Swallowing is a complex process with four phases. It initiates digestion and is essential for proper nutrition. Difficulty swallowing independently correlated with cancer survival. We retrospectively evaluated the prevalence and incidence of difficulty swallowing in an acute care palliative medicine unit. BMI and survival were also examined. Methods: Electronic Medical Records (EMR) 2010-2012 was reviewed. Assessment comprised of 3 steps: nurse survey on patient condition (coma, intubation, PEG/feeing tube, respiratory distress), screening questionnaire and clinical swallowing test. Change in BMI from the day of admission to discharge calculated. Survival calculated from EMR and Social Security Death Index. Results: N = 261 with cancer identified; 47% known metastases. The mean age (± SD) was 68 ± 13 years. 55% females. 71% Caucasians and 25% African Americans. It was common in lung, gastrointestinal (GI) and genitourinary (GU) cancers. Clinical swallowing test was indicated in 94%. Prevalence of difficulty swallowing = 6%. Incidence of difficulty swallowing = 21%. Change in Body Mass Index (BMI) from 26 ± 7 (Mean ± SD) to 26 ± 6 on admission to discharge respectively. Median (25th, 75th percentile) survival: 25(13, 62) days. Conclusions: Difficulty swallowing was common in lung, GI and GU cancers. The incidence of difficulty swallowing in acute care palliative medicine unit was 21% and prevalence 6%. 75% with difficulty swallowing identified by nurse’s initial survey, 19% through screening questionnaires and 6% clinical swallowing test. Pneumonia/respiratory and GI problems were common. Swallowing evaluation critical for comprehensive cancer care.
A population-based study of medical cannabis utilization in patients with cancer in the pre-legalization era.
Authors: Karim Safiya , Bu Jingyu , Jess Ed , Cheung Winson Y. , Kerba Marc 
Published: May 2019

e18297 Background: Between April 1, 2014 and October 17, 2018, access to cannabis for medical purposes was regulated by Health Canada. Surveys have demonstrated that cancer patients use cannabis to manage symptoms and side effects. However, medical cannabis utilization patterns in cancer patients under Health Canada’s regulatory framework have not been well-described. We aimed to determine the proportion of cancer patients who used medical cannabis, timing of use in relation to cancer treatment and sociodemographic factors predicting use in a large Canadian province. Methods: The Alberta Cancer Registry was used to identify all patients age ≥ 18 diagnosed with invasive cancer in the province from April 01, 2014 to December 31, 2016. These cases were linked to records from the College of Physicians and Surgeons of Alberta database which collects data on patients who received authorization to access medical cannabis as well as on physicians that provided the authorization. Authorization was used as a surrogate for medical cannabis utilization. Univariate and multivariate logistic regression models were constructed to determine factors associated with medical cannabis utilization. Results: We identified 41,889 patients between April 1, 2014 and December 31, 2016. Median age at cancer diagnosis was 65 and 50% were female. Among these patients, 1,070 (2.5%) used medical cannabis. Of these patients, 541 (51%) used medical cannabis within 1 year of diagnosis, 248 (52%) within one year of the start of systemic therapy and 128 (41%) within one year of the start of radiation therapy. On multivariate analysis, patients aged 18-29 (OR 12.4, 95% CI 7.8-19.7) and those receiving systemic therapy (OR 2.0, 95% CI 1.7-2.4) were more likely to use medical cannabis (p < 0.001). There were 171 unique physicians who authorized medical cannabis of which only 3.5% (6/171) were oncologists. Conclusions: A small proportion of cancer patients used medical cannabis under Health Canada’s regulatory framework. Utilization was associated with a cancer diagnosis and receiving treatment. Younger patients and those undergoing systemic treatment were predictors of medical cannabis use. Further study is required to understand utilization patterns after cannabis legalization and how to incorporate these findings into patient-centered cancer care.
Giving voice to patients: Understanding treatment preferences of patients with multiple myeloma (MM).
Authors: McKay Caroline , Maiese Eric , Chiarappa Joseph , Sarokin Laura , Cambron-Mellott M. Janelle , Maculaitis Martine , Alunni Nicole , Raje Noopur S. 
Published: May 2019

e18302 Background: Findings from few studies examining preferences for MM treatment are limited in application, as they are largely missing the voices of patients (PTs). The present qualitative study elucidates PT preferences, the perceived trade-offs they are willing to make, and how these may differ by line of therapy (LOT). Methods: Semi-structured phone interviews were conducted with MM PTs (front-line [FL] = 11, early relapse 1- 2 prior-lines [1/2PL] = 10) recruited via purposive sampling from targeted panels and PT groups, April-May 2018. A discussion guide was developed and a trained interviewer conducted 1-hour interviews on the diversity and valence of factors influencing how PTs evaluate potential regimens and how preferences vary by experience (i.e., LOT). Interviews were audio recorded and transcribed, responses coded, and content analysis performed to identify key themes emerging from textual data. Results: The sample was 42% male, mean age 64 years, with mean 58 months since diagnosis. Three key themes were identified. Firstly, treatment decision-making, revealed that trust in one’s health care provider (HCP) was a potent influence on treatment choice. Whereas FL PTs reported often only one option is offered and rely on HCP to make decisions, 1/2PL PTs consider other sources of information and engage in more shared decision-making. Secondly, expectations about treatment, illustrated that HCPs discuss important factors, e.g., efficacy and tolerability, in general terms with FL PTs and provide more details to 1/2PL PTs. Lastly, “ top of mind” factors that influenced treatment decisions, effectiveness, followed by side effects, emerged as the greatest influences on preference, although 1/2PL PTs reported less concern with side effects than FL PTs. Relatedly, quality of life was described as salient; the lived experience of treatment was often mentioned within the context of side effects. Conclusions: The way PTs construct, prioritize, and communicate about treatment when assessing “benefit-risk” is a dynamic process, based on where PTs are in their treatment journey. By examining treatment preferences grounded in PTs’ lived and changing experiences with MM, the findings may contribute to better PT-HCP engagement through treatment decision-making and improve clinical care.
Review of the treatment milestones for stage I non-small cell lung cancer at a regional rural cancer center.
Authors: Harb Antoine Joseph , L'Italien G. Allen , Sinclair Sarah , Curtis Adam 
Published: May 2019

e18305 Background: Treatment milestones were reviewed for all stage I non-small cell lung cancer (NSCLC) patients treated at Northern Light Cancer Institute (NLCI), from 2010 to 2017. Cases in which the initial time to treatment (TTT) exceeded 6 months and those not seeking treatment were considered non-typical and were excluded from analysis, resulting in 502 cases for this time period. Methods: Analysis demonstrated that patients primarily took one of three different pathways in the diagnostic process. This process typically involved a CT scan, PET scan, and a biopsy. The three primary diagnostic pathways were: CT-PET-Biopsy (29.7%), CT-Biopsy-PET (14.3%), or CT-PET (no biopsy) (39.8%), accounting for 83.9% of eligible patients. The primary mode of treatment for most patients was surgery (63.7%). Patients not eligible for surgery received stereotactic body radiation therapy (SBRT) (26.7%). Results: Patients undergoing surgery experienced a shorter average TTT compared to patients receiving SBRT for all years except 2016. (p < 0.05). Time to treatment for surgical patients was stable at approximately 70 days from 2011-2014, at which time there was an average 27.9 day increase by 2016. TTT for SBRT patients increased from a mean of 67.4 days in 2010 to a high of 110.8 days in 2015 before decreasing to 90.0 in 2016. The different diagnostic pathways did not significantly differ from each other in terms of 3 year average TTT (2015-2017) for surgical patients (p = 0.59). SBRT patients who had a two-step diagnostic pathway (CT-PET) had TTT that was 22.7 days shorter than the three step pathway of CT-PET-Biopsy (p = 0.02). Patients receiving SBRT had a 1.56 points average higher Charlson Comorbidity Index, and were an average of 4.5 years older than those receiving surgery. Conclusions: Differences in TTT between treatment modalities are likely related to patient comorbidities and additional time needed for radiation planning and simulation. The changes seen since 2015 were thought to be secondary to the emergence of prior-authorization for procedures. This was a quality study aiming to identify the current treatment milestones and related wait times for each treatment modality in an effort to further optimize patient care.
Design and implementation of outpatient-based rapid MRI protocols to rule out metastatic spinal cord compression and brain metastases.
Authors: Fried Jessica G. , Lariviere Michael Joseph , Parikh Ravi Bharat , Sullivan Patricia Zadnik , Kanter Genevieve P. , Lee John Y.K. , Malhotra Neil R. , Brem Steven , Ozturk Ali K. , Schuster James M. , Grady M. Sean , Evans Tracey L. , Alonso-Basanta Michelle , Jones Joshua Adam , Kurtz Robert , Wolf Ronald , Zafar Hanna M. , Shulman Lawrence N. , Berman Abigail T. , Kahn Charles E. 
Published: May 2019

e18307 Background: Metastatic spinal cord compression (MSCC) and symptomatic brain metastases (mets) are potential emergencies that demand coordinated multidisciplinary management. Patients (pts) with concerning symptoms are often referred to the Emergency Department (ED) for expedited imaging, but most do not require subsequent ED or inpatient management. Unnecessary ED visits incur substantial cost to the health system and patients, and cause psychosocial stress for patients often near the end-of-life. To improve access to expedited outpatient imaging for high-risk pts and reduce unnecessary ED visits, we developed outpatient rapid MRI protocols and pathways to rule out MSCC and brain mets. Methods: Tailored abbreviated MRI protocols were developed to allow rapid acquisition of brain ( < 13 minutes) and full spine ( < 25 minutes) exams. Dedicated appointments were reserved on the daily MRI schedule. Exams were immediately interpreted and reported by Radiology to the ordering clinician. This pathway was piloted within the Thoracic Oncology group beginning in 10/2018. Results: Referring specialties included Radiation Oncology (50%), Medical Oncology (36%), Pulmonology (7%), and Surgery (7%). For 6 pts who had outpatient rapid brain imaging, median time from order to exam start was 4.3 h (1.8-31) and order to final report 6.8 h (3.2-34.1). Brain mets were found in 4/6 patients. Only 1/4 positive studies required subsequent ED management. For 8 pts referred for rapid spine imaging, median time from order to exam start was 14.4 h (2.2-72.5) and order to final report 16.7 h (4.0-74.4). Only 1 patient was found to have cord compression and required ED/inpatient management. Overall, 86% of patients did not require ED or inpatient admission. 3 pts (all with negative imaging) died a median 13.4 d (1.4-28.3) after order placement. Conclusions: Outpatient rapid MRI protocols facilitate same-day imaging, interpretation, and management, improving care for thoracic oncology pts with new concerning neurologic symptoms and reducing unnecessary ED visits. Future work will expand access beyond Thoracic Oncology and further quantify improvements in cost savings and patient quality of life.
Combined oral administration of analgesia and anxiolysis for pain associated with bone marrow aspiration and biopsy.
Authors: Cerchione Claudio , Martinelli Giovanni , Catalano Lucio , Pugliese Novella , Della Pepa Roberta , Gravetti Angela , Nappi Davide , Pane Fabrizio , Martinelli Vincenzo 
Published: May 2019

e18313 Background: Bone marrow aspiration and biopsy (BMAB) is a painful procedure, and the commonly adopted local infiltration anesthesia (LIA) with lidocaine is unable to relieve the pain during the most uncomfortable phases, or the anticipatory anxiety related to pain recalling thereafter. As there are no formal guidelines for adding a sedoanalgesic premedication before beginning the BMAB, many combinations have been adopted by several authors. Our randomized and patient blinded trial aimed to evaluate, as primary end point, the efficacy and safety of opioid and benzodiazepine agent combination plus LIA in patients who underwent BMAB for hematological malignancies. Two secondary end points were: 1) to define if patients who already underwent to BMAB without LIA prefer sedoanalgesia; 2) to demonstrate if sedoanalgesia can influence the quality of the biological specimen harvested. Methods: Patients were randomly assigned into two arms for receiving either placebo plus LIA (standard group, 48,6%) or oral fentanyl citrate 200 mcg + oral midazolam 5 mg in addition to LIA (combo-group, 51,4%) during BMAB. Pre-procedural anxiety and procedural pain were assessed according to the Numered Rating Scale (NRS: 0-10), dividing the time of the procedure into five intervals (T0, T1, T2a, T2b, and T3) and evaluating discomfort grade during each moment of procedure in both groups. Cognitive function was measured before and 30 minutes after the procedure. Possible side effects were recorded, as well as the adequacy of tissue samples harvested. A total number 116 patients were enrolled in the study. 9 patients did not meet inclusion criteria and were excluded. 52 patients were randomized and assigned to standard group and 55 to combo group. Results: At T2b and T3 (corresponding to the biopsy time and time after the biopsy, respectively) there was a significantly lower ( p< 0.05) perception of pain in the patients who received sedoanalgesia (combo-group) compared to those who did not (standard group). Moreover, 100 % of the patients in combo group who had previously undergone this procedure without premedication reported that they would prefer sedoanalgesia for the subsequent procedures. Conclusions: Administration of oral analgesia and anxiolysis is a safe and feasible option to be used in outpatient setting; sedoanalgesia is very effective in reducing pain during the biopsy and it diminishes the anticipatory anxiety related to a painful procedure. Patients should have the possibility to choose between local anesthesia alone or sedoanalgesia plus local anesthesia.