bluuebunny/crossref_metadata_2025_split huggingface dataset:
Utilization of patient pager for preservation of privacy in clinic waiting room.
Authors: Kaleem Tasneem , Miller Daniel , Yanez Maresciel , Buskirk Steven J. 
Published: March 2017

192 Background: Patient privacy is of the utmost importance for the emotional needs of a cancer patient and their family. As an effort to improve privacy, quality, and coordination of care within our Radiation Oncology department, in 2016 a patient pager system was devised to inform patients to prepare for daily treatment rather than verbally call the patient's name in waiting rooms. Methods: During June 2016, patients undergoing daily radiation therapy participated in a six-question survey addressing various aspects of the paging service, privacy prior to pager use, and demographics. Six radiation therapists also participated in a 7-question survey addressing privacy and workflow. Participants rated their experience on a scale of 1 to 5 (1 being poor, 5 being excellent). Surveys were collected and retrospectively reviewed. Results: 42 patients completed the survey. Patients rated "Very Good" to "Excellent" for the following categories: “Paging system more convenient than being called”(4.6), “Protection of privacy”(4.6), “Easiness”(4.7) and whether “Pager should be utilized for all appointments” (4.3). Patients rated “Patient privacy when name is called” as "Good" to "Very Good" (3.7). Seven patients also underwent therapy prior to pager implementation and rated the new system in comparison as "Very Good" to "Excellent" for “Privacy protection”(4.6), “Efficiency” (4.6), and “Satisfaction” (4.6). Only 24 filled out demographic information. Of the 24 patients, 54% of patients were female, 87% were above the age of 50, and all patients were receiving at least 10 treatments. Staff rated "Fair" to "Very Good" for “More preparation time” (2.8), “Patient use difficulty”(3.2), “Patient positive feedback”(2.3), “Receiving patients” (2.2) and “Workflow” (2). However, “Patient privacy” was rated as "Very Good" to "Excellent" (4.2). Conclusions: Overall, patients and staff highly rated the paging system for protecting privacy in the waiting room. Patients who experienced waiting room procedure prior to pager implementation display greater satisfaction with a paging system. However, it did not change overall workflow. Our study shows clinics should prioritize patient privacy in the waiting room to improve the emotional needs of the patient.
Patterns of cancer-related health information seeking and receipt among Hispanic and non-Hispanic childhood cancer survivors.
Authors: Miller Kimberly A , Ramirez Cynthia N , Wojcik Katherine , Ritt-Olson Anamara , Baezconde-Garbanati Lourdes , Thomas Stefanie Marie , Freyer David Robert , Hamilton Ann S. , Milam Joel 
Published: March 2017

197 Background: Because childhood cancer survivors (CCS) report a high number of unmet cancer-related information needs, knowing where CCS access information may provide insights into appropriate delivery systems to address information deficits. Active seeking of health information among CCS is associated with positive health behaviors, including adherence to follow-up care. This study examined patterns of cancer-related health information seeking as an indicator of health care engagement. Methods: Participants (N = 193) were young adult CCS diagnosed with any cancer type in Los Angeles County, 54% Hispanic, with a mean age of 19.87, and at least two years from treatment. CCS were asked where they accessed health information related to their cancer with 8 response options which were categorized into four information domains: hospital resources, social media, other survivors, and family members. Multivariable logistic regression was used to assess correlates of each information domain, including sociodemographic information, post-traumatic growth, and health care engagement, controlling for age, ethnicity, sex, education, and health insurance status. Results: Hospital resources were the most frequently endorsed information domain (65.3%), and Hispanic CCS (vs. non-Hispanic) were more likely to access this source. Online sources were more likely accessed by female CCS. Seeking information from other cancer survivors was associated with follow-up care and post-traumatic growth after cancer. Hispanic CCS were less likely to seek information from other survivors and their family than non-Hispanics. Conclusions: While CCS obtain information from a variety of sources, hospital resources were the most commonly accessed, particularly for Hispanics. Information sharing between survivors may promote positive health care engagement; however, Hispanics may be less likely to pursue this resource. Future work should address barriers Hispanic CCS face in information sharing with other cancer survivors. [Table: see text]
Psychosocial distress screening at a single urban community oncology center: Trends among Hispanic and Caucasian women with newly diagnosed breast cancer.
Authors: Britt Gregory Joseph , Shay Rebecca C. , Rassmusen Monica , Vannice Sandra , Bolduan Lomax Jana M 
Published: March 2017

198 Background: We aim to describe our psychosocial distress screening program with attention to our female breast cancer population and symptoms of anxiety and depression among English-speaking Caucasians and Spanish speaking Hispanics. Methods: We retrospectively examined the emotional distress scores of 170 women with newly diagnosed breast cancer at the Cancer Centers of Colorado at SCL Heath/Saint Joseph Hospital from January-December 2015. SCL Health IRB approval was obtained. Patients were provided a distress screening questionnaire (English or Spanish) at their initial visit. Data points included: gender, age, ethnicity, primary language, emotional distress (worry/nervousness or anxiety/fears and sadness/depression) and degree of distress (“thermometer” scale 0-10 or not at all, slightly, moderately, seriously or very seriously). The degree of distress measures were revised in August 2015 from a “thermometer” scale to a descriptive scale. Results: Of 170 women studied, there were 104 Caucasian, 49 Hispanic, and 17 other race/ethnicity (including Black, Asian, Native American, and Pacific Islander). 76 women (40 Caucasian, 31 Hispanic, 5 other) did not participate in filling out the questionnaire. Of the 94 patients responding, 68% were Caucasian (n=64), 19% Hispanic (n=18), and 13% other (n=12). With regard to symptoms, 55% of Caucasians (n=35), 44% of Hispanics (n=8), and 50% of other (n=6) reported anxiety. Moreover, 36% of Caucasians (n=23), 56% of Hispanics (n=10), and 33% of other (n=4) recorded sadness/depression. Among the descriptive scale scores from August-December 2015, Hispanics were the only group to record “seriously” or “very seriously” in regard to anxiety or sadness/depression. Conclusions: Our retrospective study of emotional distress screening demonstrated lower participation among Hispanics with breast cancer. Concerns of anxiety and depression were common among all groups, with a small number of Hispanics reporting the highest levels. Emotional distress screening is an important component of cancer care for women with breast cancer and barriers for non-English speaking Hispanic patients need to be examined.
Using the symptom distress thermometer (SDT) in patients with breast cancer to identify psychosocial supportive needs.
Authors: Gillego Alyssa , Singh Rohan , Chen Siyung , Parris Celina , Winell Jeremy 
Published: March 2017

200 Background: Psychological distress is common among cancer patients. In order to optimize patient care there is a need to understand the type of patient problems contributing to distress. SDT is a well-recognized tool for assessing distress in 5 broad problem categories including, practical, family, emotional, spiritual/religious, and physical (NCCN distress guidelines: Cancer 2005). The objective of this study was to evaluate categories of distress commonly experienced by breast cancer patients undergoing radiation therapy (RT). Methods: This is a retrospective study on patient symptoms of distress as recorded on SDT surveys. Patients completing SDT have the opportunity to score distress on a scale of 0-10 and list the category of distress. For the purpose of this study, we defined low distress score to be ≤ 3, and high distress score of ≥ 4 requiring referral/intervention. Patient population included 121 patients receiving a 3-6 week course of breast RT and who completed ≥ 2 weekly surveys during therapy. A total of 433 surveys were reviewed for score and category of distress. Results: Median age was 56 years (range 32-88). Each patient completed an average of 3.58 surveys. The median distress score was 3 (range 0-10). Overall distribution of any distress by problem category was 1.6% spiritual/religious, 3.7% family, 10.6% practical, 23.3% emotional, and 60.8% physical. Further, we noted that 63 patients (53%) described a high distress score (≥ 4). Among this cohort, 47 patients (74.6%) reported that their distress was secondary to emotional problems. We observed no association between high distress score and patient age or stage of disease. Conclusions: Physical problems were the most common symptom reported on SDT in our study population. However, among the patients identified to have high distress score, emotional problems emerged as the most common cause of distress. These observations suggest that although patients undergoing treatment have many physical complaints, the more significant symptoms requiring referral/intervention were in the emotional category. The identification of more significant problems experienced by patients would help optimize their psychosocial supportive needs.
Implementation of distress testing: Lessons learned at the Kaiser Permanente Oakland Medical Center.
Authors: Washington Pamela Kim , Belote Lisa , Harder Rosalind , Livingston Patricia , Nguyen Kevin , Piper Sarah , Chen Bonnie , Piper Carol , Warren Nakeia , Stodd Kay , Carraway Raymond , Roston Richard , Barnett Nicole M , Duffy James 
Published: March 2017

202 Background: The Commission on Cancer (CoC) requires accredited facilities to evaluate cancer patients for distress a minimum of one time at a pivotal visit during their cancer journey. Here we describe lessons learned with the implementation of distress testing at the Kaiser Permanente Oakland Medical Center. Methods: The implementation timeframe was April to December 2015. Testing guidelines were created including a definition of pivotal visit. Use of the validated NCCN Distress Thermometer was approved by the East Bay Comprehensive Cancer Committee. A workflow was developed whereby a paper copy of the tool was given to patients at their first cycle of chemotherapy. A RN Case Manager or Social Worker then triaged completed forms. Referrals were made by the case manager, social worker, or attending physician based on patients’ self-reported disposition and level of distress. This information was subsequently entered into patients’ electronic medical record. Completed forms were then entered into an Excel database to facilitate data analysis. Results: Overall, patients were receptive to testing. 232 tests were completed. 55.7% (n = 125) self-reported a score between 0 to 3 (low distress). Worry, fatigue, problems with sleep, financial issues, and problems with transportation were the most common stressors. 42.7% patients received a referral. Referrals to a MSW or RN Case Manager were most common. Interestingly, there were no referrals to psychiatric services. Conclusions: Careful consideration to workflow processes be must factored into implementing distress testing. Findings from our 2015 pilot informed the expansion of testing in all outpatient cancer clinics in 2016.
Biopsychosocial distress assessment among testicular cancer survivors (TCS) using electronic patient reported outcomes (PROs).
Authors: Guancial Elizabeth A. , Peckham Jennifer , Baumhauer Judith , Mohile Supriya Gupta , Sahasrabudhe Deepak M. , Duberstein Paul , Fung Chunkit 
Published: March 2017

204 Background: Distressis a frequently endorsed experience by cancer patients.Many organizations advocate formal distress screening as part of clinical care in order to better meet the “psychological, social, and/or spiritual needs of patients that may interfere with the ability to cope effectively with cancer, its physical symptoms, and its treatments.” The primary objective of this study is to characterize distress levels among TCS using electronic PROs via a modified version of the National Comprehensive Cancer Network Distress Thermometer (DT) and Patient Reported Outcomes Measurement System (PROMIS). Methods: Eligible TCS ( < 69 years at diagnosis, any treatments, not in active or maintenance stage of exercise behavior) enrolled onto a pilot study of an electronic, self-directed, individually tailored “EXercise for CAncer Patients” (EXCAP) program were offered iPad-based distress screening during routine medical oncology clinic visits. Screening consisted of a modified DT, where patients self-report distress on a scale of 1-10, wherein scores of greater than 4 refer to increased distress, as well as PROMIS domains for anxiety and depression, where scores range from 0-100, 50 is the average for the United States (US) general population, and higher values indicate more anxiety or depression. Results: A total of 18 TCS (median age 44) enrolled in the EXCAP study as of May 31, 2016. Among participants, 56%, 28% and 17% had stage I, II, and III testicular cancer, respectively. Treatment modality and median time from treatment to enrollment were: 78% orchiectomy, 23.5 months (range 1-204); 33% retroperitoneal lymph node dissection, 8 months (range 1-48); and 72% chemotherapy, 22 months (range 3-587). TCS completed a median of 2 distress screenings (range 1-8). The median DT score was 3 (range 1-8). Median PROMIS anxiety and depression scores were 52.88 (32.87-69.36) and 51.02 (34.17-6.65). Conclusions: TCS self-report low levels of distress on the DT and PROMIS scores for anxiety and depression that are comparable to the US general population. Future research will explore associations between patient- and disease-specific factors and distress in TCS.
From helplessness to self help: Breast cancer surviorship in India.
Authors: DeSouza Rebecca , Nag Shona Milon , Sivaram Rama , Mane Anupama Dutt 
Published: March 2017

208 Background: In The Indian Scenario, a diagnosis of cancer is accompanied with social stigma and emotional upheavals, especially in breast cancer patients. They are typically thinking: “I would be less of a woman,” “I don’t know if people understand me,” “I feel isolated from myself, my family and my friends,” “Would I be normal again?” “Do I know how to help myself?” or “What will happen in the future, to my kids, to my husband?” Methods: All of these concerns are not always addressed by the medical professions. To address these issues, the Indian Breast Cancer Survivors Conference was organized as an annual conference with an attendance of 200-250 breast cancer survivors from the state of Maharashtra, India. The conference would address the psychological, emotional and social distress experienced by the patients with an aim from living a longer life to living a better and fulfilled life. Results: The emphasis of the sessions were educational (with recent updates on the surgical, medical and radiation therapy aspects of breast cancer treatment), practical (emphasized important issues like side-effects of treatment, patient advocacy, complementary therapies, spirituality, lifestyle changes, etc.), and entertaining. The summary and outcomes of the last 5 annual survivorship conferences will be described and enumerated. Results of questionnaires administered during the last 2 conferences and addressing health behavior patterns of survivors will be presented. Conclusions: We can evaluate through post conference support group discussions and conference feedback, qualify patient psychological and social health as 1) Physical:There are side effects but I choose to go on; 2) Mental: There are times that I am low, depressed, anxious, scared, guilty, but this is my new normal; 3) Emotional:Little things upset me, angry quickly but I am dealing with it; 4)Spiritual:Moved away from bargaining with God to accepting, from rituals to spiritual; 5) Social:don’t hesitate to reach out for support and to support; and 5) Intellectual:Knowledge is power, so I have learned to ask, to question, and then to decide. Achieving psychological and social health is the effort of the patient, the treating team and the support group.
Loss in working years after a breast cancer diagnosis: A population-based study (Sweden).
Authors: Lambe Mats , Lambert Paul , Fredriksson Irma , Plym Anna 
Published: March 2017

209 Background: More than half of all women with breast cancer are diagnosed during working age. We present a new measure of clinical and public health relevance to estimate the loss in working years after a breast cancer diagnosis. Methods: Women of working age diagnosed with breast cancer between 1997 and 2012 were identified in the Breast Cancer Data Base Sweden (N = 19,661), together with a breast cancer-free comparison cohort (N = 81,303). Women were followed until permanent exit from the labour market (defined as receipt of disability pension, old-age retirement or death) or censoring. Using flexible parametric survival modelling, the loss in working years was calculated as the difference in the remaining years in the work force between women with and women without breast cancer. Results: The loss in working years was most pronounced in women of younger ages and in women with advanced stage disease. Women aged 50 years at diagnosis with stage I disease lost on average 0.6 years (95% CI, 0.4-0.8) of their remaining working time; the corresponding estimates were 1.2 years (1.0-1.5) in stage II, 3.2 years (2.7-3.7) in stage III, and 8.8 years (7.9-9.8) in stage IV disease. Type of treatment was a clear determinant in women with early stage disease, with a higher loss in working years among women treated with axillary surgery, mastectomy and chemotherapy. Conclusions: Our measure provides a new perspective of the burden of breast cancer in women of working age. The modest loss in working years in women with early stage disease is reassuring, although the economic consequences on a population-level are likely to be high given the large number of women diagnosed with breast cancer every year.
Comanagement and emergency room admissions in oncology practice.
Authors: Slim Jennifer Nadine , Loch Michelle Marie 
Published: March 2017

21 Background: Cancer survivors face many challenges and encompass a multitude of specialties. These patients frequently utilize emergency room services with increased admission rates and, often, significant consequences on health care costs. National Hospital Ambulatory Medical Care Survey data from 2011 reports non-ischemic heart disease, chest pain and pneumonia as the most common emergency room discharge diagnoses for adults. We hypothesized that cancer survivors who continue care with primary providers require fewer emergency room based admissions. Our purpose in identifying these demographics was to allow for further consideration of specific interventions that might improve out patient based management. Methods: We considered ongoing primary care as those assigned to a primary care provider. We developed a memorandum of intention to identify patients at risk for over utilization of emergency room services. We gathered anonymous data about oncology patients seen in clinic from July 2014 to August 2015. We were able to determine how many emergency room based admissions were attributed to these patients as well as patients with and without primary care providers assigned in the EMR. We further attempted to identify those at higher risk taking into account co-morbid diagnoses. Results: 2,627 survivors were seen in clinic with 163 emergency room based admissions. 75% of these patients did not have a primary care provider identified in EPIC and account for 51% of the admissions. Only two patients had 3 or fewer co-morbid diagnoses. The most common co-morbid diagnoses among patients with emergency room based admission were abdominal pain, anemia, and chest pain. Conclusions: This data would suggest that co-management with primary care providers alone is not adequate for cancer survivors. While about half of the admissions were those without assigned primary care; the overall percentage of admission was higher from those assigned primary care providers. We suggest risk factors and management strategies are unique to survivors and require a focused multidisciplinary approach. Further study focused on interventions unique to cancer survivors are warranted.
Couples symptom burden in oncology care: Perception of self and the other.
Authors: Lopez Gabriel , Milbury Kathrin , Li Yisheng , Chen Minxing , Dutton Casey , Hashmi Yousra , Bruera Eduardo , Cohen Lorenzo 
Published: March 2017

213 Background: Cancer survivors and their caregivers have symptoms that wax and wane over time and are interrelated. We report on the results of a communication survey exploring symptom burden in couples presenting for care in an integrative oncology (IO) clinic. Methods: Couples were approached for participation while waiting for an IO service (Physician Consultation, Massage, Acupuncture, Physical Therapy, Nutrition). 50 patients and their partner completed the Edmonton Symptom Assessment Scale (ESAS; 0-10, 10 worst). Patient and partner each completed two ESAS forms: one for themselves and one for their perception of the other’s symptoms. Each also completed a Global Health scale (PROMIS 10). ESAS distress subscales analyzed included Psychological (PSS) and Physical (PHS). Paired t-tests were used to examine all measures. Results: Patients (58% female) had most frequent cancer diagnoses of breast (22%) and gastrointestinal (18%). Patients rated their own physical symptoms of Fatigue (p = 0.002), Nausea (p < 0.001), Drowsiness (p = 0.032), Appetite (p = 0.008), and Shortness of Breath (p = 0.001) significantly higher than their partner’s rating of their symptoms. Patient self-rating for psychosocial symptoms of anxiety and depression was not significantly different from partner rating of patient symptoms. Partners were more accurate rating psychological symptoms (ESAS PSS, patient 3.89 vs partner 3.72, p = 0.836) and less accurate interpreting physical symptoms (ESAS PHS, patient 16.43 vs partner 9.94, p < 0.001). Except for Sleep, Financial Distress, and Spiritual Pain, partners rated all their own symptoms significantly lower compared to patient’s rating of them (all p’s < 0.001). Patients reported significantly lower global health (36.9 vs 42.9, p < 0.001) and physical health (16.6 vs 20.2, p < 0.001); no differences were observed for mental health for patients vs caregivers (14.2 vs 15.12, p = 0.1). Conclusions: Our findings suggest that partners may better perceive psychological stressors expressed by patients but may be less sensitive to physical symptoms. Interventions aimed at assisting caregivers in better understanding patient physical symptom burden are warranted.