bluuebunny/crossref_metadata_2025_split huggingface dataset:
Likelihood of subsequent chemotherapy after acute rehabilitation in patients with advanced cancer.
Authors: Bromberg Isaac Martin , Knight Louise , Dy Sydney Morss 
Published: February 2017

32 Background: Patients with advanced cancer suffer acute declines in their functional status for a variety of reasons, including progression of disease, adverse effects of medical or surgical treatment, and exacerbation of a chronic non-cancer condition. The use of rehabilitation services to improve functional status for patients with advanced cancer has been increasing, but the likelihood that a patient will achieve the goals of continued cancer treatment or extended survival has not yet been demonstrated. Times of transition in a patient’s course of illness present opportunities for discussion of goals of care. Methods: The objective of this study was to determine how often patients who were referred to acute rehabilitation (AR) returned to the cancer center for further chemotherapy. A secondary end-point was length of survival after referral. Records of patients admitted to the medical oncology service of an academic cancer center who were referred to AR between January 1, and December 31, 2012, were retrospectively reviewed for the following information: age, gender, race, primary malignancy type, subsequent chemotherapy, and date of death. Results: A total of 43 individual patients were referred for AR. Of these, 22 (51.2%) were 65 years of age or older, 30 (69.8%) were male, 32 (74.4%) were of white race. Primary hematologic malignancies accounted for 26 (60.5%) of the patients, 12 (27.9%) had non-brain solid primary tumors, and 5 (11.6%) had a primary brain tumor. For the 43 patients who qualified for AR, 33 (76.7%) were transferred to an AR facility, 9 (20.9%) were discharged to home, and 1 (2.3%) died in the hospital prior to discharge. Of those 33 patients who went to AR, 17 (51.5%) received further chemotherapy. Of note, 18 (54.5%) of the patients referred to AR died within 6 months (range 17-158 days), and 22 (66.6%) died within one year. Conclusions: Furthercancer treatment after an acute rehabilitation admission is a reasonable goal for patients with advanced cancer; however, these patients frequently have a limited life expectancy and should be considered for palliative care consultation prior to discharge to ensure a discussion about goals of care, in light of their overall prognosis.
Results from year 1 of an embedded supportive oncology practice.
Authors: Scarborough Bethann , Chai Emily , Holcombe Randall F. , Lee Eric , Goldstein Nathan 
Published: February 2017

40 Background: We present the findings from our first year of a Supportive Oncology practice embedded in a quaternary care center’s outpatient cancer practice. Methods: One palliative medicine physician saw patients 4 days per week. Oncologists made referrals for symptom management, psychosocial support, advance care planning, or by predetermined triggers for palliative care. Results: 239 patients were referred for a total of 821 visits. Palliative care referrals increased over time; 0.6% of the cancer center’s patients were referred in the first quarter and 1.5% were referred in the third quarter. Referral reasons included symptom management/support (90%), goals of care (5%), or triggers (6%). Six to 9 symptoms were addressed at 41% of visits. Sixteen percent of patients initially referred for symptoms were later seen for conversations regarding goals of care. Of these patients, 76% discussed goals of care with their oncologist, 61% were referred to hospice and 47% enrolled in hospice. Supportive oncology visits were associated with decreased health care utilization, with a downward trend in Emergency Department visits (0.82 vs. 0.72 per patient) and inpatient admissions (0.91 vs. 0.84 per patient) after the initial palliative care visit compared to use before the visit. Approximately 17% of all Supportive Oncology patients enrolled in hospice. Conclusions: Our first year of an embedded palliative care practice focused on building collaborative relationships. The steady referral growth over time indicates that oncologists increasingly accepted the program. While only a small proportion of patients were referred, the high visit complexity reflects this population’s acuity. Decreased health care utilization may be due to better symptom control or care aligned with patients’ values. Early referrals for symptom management facilitate goals of care discussions later on, and the importance of delivering a unified message on treatment options is seen in the hospice referral rate of 61% for the subset of patients who discussed goals of care with palliative care and oncology. Embedding palliative care in oncology fosters expert symptom management, seamless communication, and trusting relationships between oncologists, palliative care, and patients.
A preliminary study of attitudes toward the assessment and management of cancer cachexia among medical oncologists and nurses.
Authors: Del Fabbro Egidio , Vigano Antonio A.L. 
Published: February 2017

44 Background: A recent international consensus on the definition and classification of the cancer anorexia / cachexia syndrome (CACS) will facilitate clinical trial design, development of practice guidelines, and routine clinical management. Non-pharmacological interventions such as dietary counseling and promising new drugs have demonstrated improved outcomes in preliminary trials. Management of nutritional impact symptoms such as severe pain, depression, early satiety and chronic nausea also produce weight gain. These important advances contrast with the apparent low priority given to this condition by oncological societies worldwide. Our objective was to evaluate the attitudes of medical oncologists and nurses in the assessment and management of CACS in non-small cell lung cancer. Methods: Surveys were administered electronically to US-based, community medical oncologists (n=76 respondents) and oncology nurses (n=25), members of the Sermo research database which includes over 275,000 active healthcare providers, pre-qualified through telephone or online screening. A proprietary MedPulse tool achieved random geographic distribution of respondents through a staged query–response process. Results: 67% of medical oncologists selected weight loss as the most important criterion for diagnosing CACS in their daily practice, consistent with the consensus definition. However, only 4% of respondents described CACS as inevitable or very likely to develop in patients maintaining good performance status through first-line therapy. Community providers identified the management of symptoms that affect appetite as very important (58.8%), important (31.4%) or somewhat important (7.8%), but only 9.8% indicated they currently use a formal tool to evaluate these symptoms. 72% would consider using a brief assessment tool in clinical practice. Conclusions: Our surveys suggest community oncologists recognize the core criteria for the diagnosis of CACS, although there may be under-recognition of the condition’s prevalence. There is considerable interest in adopting a brief symptom assessment tool for screening, management and referral of affected or at-risk patients.
Managing symptoms when “the first step or two isn’t working”: Provider and patient perceptions of the role of specialty palliative care in symptom management in gynecologic oncology.
Authors: Lefkowits Carolyn , Kavalieratos Dio , Arida Janet , Teuteberg Winifred , Donovan Heidi , Courtney-Brooks Madeleine , Arnold Robert , Kelley Joseph L. 
Published: February 2017

47 Background: Our objective was to describe gynecologic oncology (GO) providers’ and patients’ knowledge, attitudes and preferences related to utilization of specialist palliative care (SPC) for symptom management. Methods: Semi-structured qualitative interviews with 19 GO providers (7 physicians, 7 advanced practice providers, 5 nurses) and 30 patients with advanced or recurrent gynecologic cancer from an academic medical center. Key interview domains include: patient symptoms, perceived role of oncology team regarding symptom management, familiarity with SPC, and barriers and facilitators to utilization of SPC for symptom management. Qualitative analysis is underway. Results: 19 provider interviews and 29 patient interviews were completed. Preliminary findings indicate shared beliefs between providers and patients, including an overall willingness to involve SPC in symptom management. Although providers felt comfortable initially managing common symptoms, they expressed interest in involving SPC for complex or multiple symptoms. Patients do not expect their GO providers to manage severe symptoms, noting concerns of complex symptom management as burdensome to the GO team. Barriers to involving SPC in symptom management included: patients’ perceptions of SPC as synonymous with end-of-life care, and logistical issues (e.g., scheduling and transportation). When a distinction was drawn between SPC for symptom management and end-of-life care, patients were uniformly open to seeing SPC for symptom management. Conclusions: GO patients’ and providers’ perception of the role of oncology providers in symptom management is consistent with the concept of a primary palliative care provider, delivering initial management of common symptoms. Specialty palliative care services are seen as complementary to the GO providers’ skillset and particularly useful for severe or multiple symptoms. Implications include the importance of ensuring that oncology provider training includes dedicated attention to symptom management to enable them to fulfill the role of primary palliative care provider.
Integrating palliative care into care of patients with kidney cancer and melanoma.
Authors: Buss Mary K. , DeSanto-Madeya Susan , Lynch Jessica , Zerillo Jessica A. , McDermott David F. 
Published: February 2017

56 Background: Early palliative care (PC) has been shown to improve quality of life (QOL), enhance quality end-of-life (EOL) care, and reduce costs, yet many cancer centers lack resources to provide outpatient palliative care services. Data is needed to identify the optimal timing and most effective and efficient model for integrating PC into the care of cancer patients. In order to understand what components of PC have the greatest impact on patients, we examined the acceptability of early PC among patients with kidney cancer (RCC) and melanoma (M) and describe the content of PC visits. Methods: In July 2013, the outpatient PC team at Beth Israel Deaconess Medical Center, including physician (MD), social worker (SW) and chaplain (chap) were invited to see patients within a clinic that specializes in seeing patients with advanced RCC and M. All patients completed data on symptom burden using the Edmonton Symptom Assessment Scale, measures of QOL and degree of psycho-social and spiritual support. Referral to PC was based on these metrics and physician discretion. Results: Of the 21 patients seen by PC, 57% had RCC; 76% male; 86% White; 57% married. Mean age was 62 (range: 36-87). At the 1st PC visit: All had locally adv/metastatic disease; 48% were being treated with curative intent; 29% had not yet started treatment; 57% rated pain 0 on 0-10 scale (range: 0-9). First PC visit content: 76% psychosocial support (including building rapport); 67% symptom management; 33% included advance care planning (ACP) and decision-making support. Ninety-one percent were seen >1 by PC; 19% seen by SW or chap; median PC visits: 3. Eighty-one percent completed health care proxy. Additional data on patient outcomes will be presented. Conclusions: Nearly half of patients seen by PC were being treated with curative intent, suggesting acceptability of early PC integration in patients with RCC and M. Symptom management and psychosocial support dominated the early PC visits.
Impact of a cancer of unknown primary (CUP) service on end-of-life planning for patients with metastatic cancer.
Authors: Weatherstone Katie , Stewart James , Marshall Jackie , Gillmore Roopinder 
Published: February 2017

66 Background: Cancer of Unknown Primary (CUP) is the 4th most common cause of cancer death in England and Wales. [(Office for National Statistics, Mortality Statistics: Deaths registered in England and Wales. http://www.ons.gov.uk/ons/search/index.html?newquery=series+dr (accessed 1/7/14).] Patients with CUP have poor outcomes secondary to delayed, inappropriate investigations and poor treatment response. In line with NICE guidance [(NICE guidelines: CG 104 (July 2010).]. Metastatic malignant disease of unknown primary: diagnosis and management of metastatic malignant disease of unknown primary.) a CUP service was set-up at the Royal Free in June 2012. This analysis assessed its impact on patients diagnosed with metastatic cancer who were not fit for active treatment. Methods: Clinical notes were reviewed for all admissions with an imaging-based diagnosis of metastatic cancer. A retrospective analysis (January-April 2009) was compared to prospective data following the launch of the CUP service (June-December 2012). Results: The notes of 9 patients (2009) and 15 patients (2012) were compared (see table). Age and length of stay (LOS) were analysed using t-test, other data were compared using chi-squared test. All patients were reviewed by Oncology and Palliative Care teams. There was a significant reduction in mean LOS (6.7 days, 18.6 days p<0.004) and the number who died in hospital (7%, 67% p<0.002) with only one patient not dying in his preferred place. Conclusions: Prompt assessment by the CUP service facilitates early input from Oncology and Palliative Care teams resulting in reduced LOS and fewer deaths in hospital in keeping with the agenda of the End of Life Care Strategy [(End of Life Care Strategy: Promoting high quality care for all adults at the end of life (July 2008). DOH (England).]. [Table: see text]
Palliative treatment the malignant trachea-bronchial stenosis.
Authors: Yang Renjie 
Published: February 2017

70 Background: To evaluate the safety and usefulness of interventional procedure and stent placement in palliative care the patients with malignant trachea-bronchial stricture. Methods: All 52 lung cancer patient, male 38, female 14, age from 27~82 years old. On pathological type: squamous cell carcinoma 31, small cell carcinoma 11, adenocarcinoma 8 and cystadenocarcinoma 2 cases respectively. Clinical symptoms consist of severe dyspnea, choke and fever. For the interventional materials are guide wire, single curved catheter, coaxial delivery set and expandable metallic stent (Gianturco Z stent, wallstent and home-made NiTi alloy stent). Results: Totally 62 stents were planted in 52 cases, successful rate was 100%. The symptoms of dyspnea immediately relieved after stent placement. The slight stimulate cough usually recovered within 1 week. Following the stenting 17 patients accepted radiation, 21 patients got systematic chemotherapy; and 3 cases done pulmonary lesions cryoablation. Stent inside stent was done in 7 cases because tumor ingrowth. The immediate imaging showed the stricture segment of trachea lumen was dilated in varied degree. The implanted stents were dilated perfectly within one week and there was no stent migration on follow up. Conclusions: The trachea-bronchial stenosis caused by lung cancer can be palliative managed by stent implantation. It’s a good method to improve patient’s quality of life and benefit for the patient continue therapeutics.
Stereotactic radiation therapy in painful bone metastases.
Authors: Katsochi Despina , Paraskevopoulou Chryssa , Kosmidis Sophia , Fotopoulou Ekaterini , Kollias George 
Published: February 2017

74 Background: Disease local control and therefore pain relief is the main objective in patients with painful bone metastases. The introduction of Stereotactic Body Radiation Therapy in combination with image guided radiotherapy offers the opportunity to safely apply hypofractionated schemes. Methods: From May 2009 to May 2014, 104 patients with total 158 single or multiple bone metastases from several primary tumors were treated with Stereotactic Body Radiation Therapy with palliative intent. Concrete osteolytic or painful osteoblastic lesions of maximum length 3cm where treated with two hypofractionated schemes: 24Gy in 6 fractions or 21Gy in 3 fractions depending on lesion size and location. All patients were provided with MDStation software installed on a tablet that analyzes their behavioral change based on evaluation questionnaires on their clinical status and pain intensity. Results: All patients completed the treatment plan with no major toxicity. Follow up was scheduled at the end of the treatment, three and six months after. Total pain relief was achieved in 130 lesions (82%), while in the rest 28 sites (18%) pain was significantly less and patients decreased medication. Conclusions: Stereotactic Body Radiation Therapy for bone metastases is a very effective technique for pain management. Palliation is achieved quite promptly with minimal toxicity.
Dying for advice: Code-status discussions between resident physicians and patients with advanced cancer—A national survey.
Authors: Einstein David Johnson , Einstein Katherine Levine , Mathew Paul 
Published: February 2017

83 Background: Patients with treatment-resistant advanced cancer rarely benefit from cardiopulmonary resuscitation (CPR) but infrequently discuss end-of-life care with a physician until hospitalized for deterioration. Admitting resident physicians may therefore conduct initial code-status discussions, but may elicit patients’ preferences without providing necessary guidance. Methods: We distributed a case-based survey to all United States internal medicine residency program directors, of whom 19 enrolled and forwarded the survey to their residents. 358 residents (response rate 22.0%) completed the survey. Results: Faced with a hypothetical case of an inpatient with treatment-refractory advanced cancer, nearly all residents felt CPR would not be helpful. Yet, fewer than half (46.7%) of residents were likely to discuss an estimate of prognosis and the value of CPR with the patient. Only 30% were likely to offer a specific recommendation on CPR. A majority (69%) of residents who were unwilling to make a recommendation stated that patients should make their decisions independently. Most residents report that a sense of responsibility is the primary reason to discuss code status independent of attending physicians, and that deference to patient autonomy prevented them from sharing knowledge of outcomes or offering guidance. Ultimately, a minority stated they were satisfied with end-of-life discussions. Conclusions: Internal medicine resident physicians in the United States are unlikely to share the poor prognosis or offer specific recommendations on CPR in treatment-refractory cancer principally because of a conflict with their concept of patient autonomy. Given the futility associated with CPR in this setting, these data define a major unmet need in training and practice.
Estimation of risk in cancer patients undergoing palliative procedures by the American College of Surgeons risk calculator.
Authors: Rodriguez Rodrigo Andres , McClain Molly , Fahy Bridget N. , Morris Katherine Teresa 
Published: February 2017

93 Background: Surgical palliation is defined as the use of a procedure in patients with incurable disease to relieve symptoms. The American College of Surgeons Risk Calculator (ACSRC) was created based on data from the National Surgical Quality Improvement Program to predict the risk of surgical complications on a patient specific level. Whether the ACSRC can accurately predict the risk of postoperative complications following palliative procedures in cancer patients is unknown. The purpose of this study was to determine if the ACSRC accurately predicted postoperative complication rates in this setting. Methods: Our surgical oncology database of patients treated from 2011 to 2013 was queried. Thirty-two patients who underwent palliative procedures were identified. Data extracted included: demographics, comorbidities, site and stage of cancer, type of procedure and post-operative complication rate and type. Risk assessment was performed for each patient using the ACSRC. Actual frequency of complications and length of stay (LOS) were compared to ACSRC predicted rate of complications and LOS. Results: See Table. Conclusions: The ACSRC is a powerful tool for aid in surgical decision-making; however, in the case of palliative procedures, it overestimated the risk of postoperative complications and underestimated the LOS. Overestimation of postoperative complications could result in fewer patients being offered potentially beneficial palliative procedures. [Table: see text]
Does performing en bloc versus piecemeal mucosal resections affect outcomes in patients with intramucosal adenocarcinoma?
Authors: Chu Chuanlian , Leggett Cadman , Uno Kname , Lutzke Lori , WANG Kenneth 
Published: February 2017

1 Background: Endoscopic resection (ER) is used to treat early esophageal cancers (EAC). With the advent of techniques such as ESD that can remove large lesions en bloc, it is important to determine if performing piecemeal resections of intramucosal cancers is detrimental. Aim: To evaluate the response rates in patients with esophageal intramucosal adenocarcinoma (IMC) who had a single ER (SR) compared to those treated with piecemeal resection (PR). Methods: This is a cohort study of patients being followed in our BE unit. Patients in a prospectively maintained database with EAC from Jan 1998 to Apr 2012 were assessed. IMC was defined as lesions that were intramucosal without extension into the submucosa. All T1a cancers were verified by two expert gastrointestinal pathologists. We compared the tumor characteristics and recurrence rate between the two groups of SR and PR of IMC. Results: A total of 197 IMC (T1a) lesions in 138 patients were identified. 88(44.7%) lesions were performed SR and 109(55.3%) were PR. Mean follow up time were 45 months (IQR 24-70.5) in SR and 39 months (IQR 26-52, P=0.067) in PR. Complete remission were found of 92.1% (81) in SR and of 93.6% (102) in PR (P=0.788) patients. The recurrence rate was 7.9% in the SR patients, and 6.4% in the PR patients (P=0.699). Median time to progression was 12 months in the SR group (IQR 8-23.5) and 11 months in the PR (IQR 8-22) (P=0.765) group. The mean survival duration was 116.3 months in the SR and 89 months in the PR (P=0.079). No statistical difference in 5-year survival rates was found between SR (83.2%) and PR (80.9%) (P=0.082). Cox proportional hazard model analysis showed local recurrence after EMR was not related to number of specimen resected or technique. Conclusions: PR appears to be as effective a therapy as en bloc for esophageal IMC. Using PR does not appear to affect clinical outcomes.