bluuebunny/crossref_metadata_2025_split huggingface dataset:
Medical repatriation at end of life: Barriers, facilitation, and fulfillment—A case-series study at a New York public hospital.
Authors: Seetharamu Nagashree , Ma Hilary Y. , Smeltz Robert , Schindewolf Jessica , Empalmado Mariam , Cohen Susan E. 
Published: February 2017

141 Background: Foreign-born cancer patients frequently desire to return to their home country at the end of life. However, many barriers can make this process challenging. We herein present our recent experience with such patients. Methods: We reviewed charts of terminal cancer patients (pts) who traveled to their homeland at the end of life. Pts’ age, diagnoses, co-morbidities, prior cancer-directed treatment, predicted survival, symptoms, code status, admissions within 4 weeks of travel, oxygen need were noted. Interval between decision to travel and travel date, events during travel, and feedback from families, if available were collected. Results: 17 charts (11 female, 6 male) were analyzed. Mean age was 60 years and the most common diagnosis was thoracic malignancy (70%, 12 pts). All pts had disseminated cancer and had received an average of 2 lines of cancer-directed therapy. All had progressive cancers with expected survival <6 months. All were under the care of medical oncologists, palliative care and social work. The mean interval between decision to travel and travel date was 9 days. 8 were hospitalized at least once in the 4 weeks prior to the day of travel and 6 were cared for as inpatients immediately prior to travel. 11 pts were receiving opioids for pain and 3 were oxygen-dependent. 10 had documented discussions regarding resuscitation and 9 were discharged with New York State out-of –hospital DNR forms. All were discharged with medical records, medication supply and provider contact information. Mean travel distance was 4,099 miles. Provider concerns for decompensation during travel included brain herniation (2), spinal cord compression (3), bleeding (1), and sepsis (2). 16 pts successfully completed their journey. 1 pt died en-route prior to boarding the aircraft. 12 pts/families provided positive feedback about the experience. Conclusions: Return to homeland is an important goal for many terminally ill cancer pts and should be a routine part of end-of-life discussions. Medical repatriation can be accomplished when conducted in a planned, well-coordinated manner. Insights from this review can help us create guidelines that can be readily applied to specific scenarios.
Specialized outpatient palliative care: Results from a representative survey among physicians in Germany.
Authors: Papke Jens Hermann , Lux Eberhard A , Marggraf Kerstin , Fricker Ruth 
Published: February 2017

143 Background: Specialized ambulatory palliative care (SAPV) allows patients with incurable diseases and limited life expectancy to be cared for until death in their familiar surroundings. In Germany, these services must be prescribed by a physician. Little is known about structure, organization and work pattern within the SAPV teams. Methods: An online survey was carried out between Sept. 2013 and March 2014 with 124 physicians in Germany with regard to aspects related to physicians’ qualification, networks and palliative care teams. Aim of this survey was to evaluate status quo of SAPV from physicians´ viewpoint. Results: All 124 respondents were enrolled in SAPV; 18.3% of them (n=22) were on a direct contract with a health insurance provider. An additional qualification for palliative medicine and for pain therapy was reported by 96.7% and 21.5% of the physicians, respectively. In average, 11.6 physicians are organized in a SAPV-network. The networks comprise general practitioners (in 88.6% of the networks) anesthesiologists (in 62.3%), hematologists/oncologists (in 57.9%) and internists (in 43.9% of the networks) as well as a large proportion of non-medical professions such as pastors, pharmacists, social workers, psychologists and nurses. In most cases, SAPV networks are linked to one or more medical practices, hospitals or welfare institutions. 96% of the respondents assessed the cooperation within the network as “very good”/“good”. Patients admitted to SAPV were mostly suffering from cancer, but also from cardiovascular, neurological and respiratory diseases. The mean duration of care was 26.6 days; 81.4% of them could die in familiar domestic surroundings. On average, one physician is treating 9.7 SAPV-patients at the same time. Documentation requires 25.9% of time spent for medical care. Problems concerning reimbursement were reported by 75.8% of respondents. Conclusions: This survey provides the status quo of the German SAPV concept. Physicians enrolled in SAPV are highly qualified for palliative care and pain therapy. SAPV is a domain of outpatient care sector. While interdisciplinary cooperation within the SAPV networks is good, documentation and reimbursement remains a problem.
Characteristics and outcomes of palliative care patients in intensive care unit.
Authors: Fumis Renata R. L. , Ranzani Otavio Tavares , Martins Paulo Sergio , Schettino Guilherme De Paula Pinto 
Published: February 2017

145 Background: Despite the growing palliative care movement, most admissions still occur in Intensive Care Units. The aim of this study was to determine the frequency of palliative care patients admitted in an ICU and assessed their outcomes. Methods: This prospective study was conducted in a tertiary private hospital, in an adult medical-surgical ICU with 22-bed in São Paulo, Brazil. Patients or their family member with ICU stay ≥ 48 hours were invited to participate. They were excluded if they had no conditions to answer the questionnaire or if they refuse to participate. During ICU stay we analyzed through the medical records and questionnaire their clinical condition and their oncologic status. We called them by telephonic assessment to assess their survival. Results: From March 2011 to March 2013 a total of 576 ICU patients were analyzed; of these, 280 were oncologic patients and 95 were palliative care. Of total, the majority was male gender (57.8%), median age was 67[54-79] years, SAPS III score was 54±18.4 points, SOFA was 3.1±3.0 and ICU Length of stay (LOS) was 9.0±11.3 days. ICU mortality was 16.5%, 1-month mortality was 22% and 3-months cumulative mortality was 28.6%. We could observe that palliative care patients were in majority cancer patients (75%vs 43.4%,p<0.001), with metastatic disease(81.7 vs 36.3, p<0.001), had greater mean time of initial diagnosis(3.21±3.7 vs 2.17±2.5, p=0.009), had greater ICU LOS (14.2±16.2 days vs 7.96±9.8, p<0.001) greater mean SAPS III (68.5±16.0 vs p<0.001) and SOFA (4.81±3.2 vs 2.81±2.8, p<0.001) when compared with non palliative patients care. They also needed more mechanical ventilation (50.0%vs32.6%, p=0.001), tracheotomy (11.6%vs 5.0%,p=0.014) and vasopressors (54.7% vs 36.8,p=0.001). The ICU mortality was greater (32.6% vs 6.8%, p<0.001), 1-month (60.0% vs 14.0%, p<0.001) and 3-months (73.5% vs 19.1%). Conclusions: Palliative care suffers most in Intensive Care Unit and we observed a high mortality at 3-months after ICU discharge. We recommend more discussions before palliative care patient’s admissions in ICU to better provide them quality of life.
Patient-centered conversations: Advance care planning values in the adult oncology population.
Authors: Mikan Sabrina Q. , Hoverman J. Russell 
Published: February 2017

147 Background: Over the past 2 years a structured advance care planning program (ACP) has been created, piloted and is evaluated monthly at 10 Texas Oncology practices. This program is a systematic process for assessing patient values, is physician supported and is delivered by advanced practice providers at each site. Patient values and quality of life are at the center of the conversations, enhancing patient-centered care and communication with their oncology providers. Targeted patient populations include metastatic lung, pancreatic and colon cancers. Methods: Over the past 14 months, 332 patients engaged in ACP in ten sites. Descriptive statistics for each site were calculated and examined to explore 1) ACP counseling sessions, 2) number of Patient Values questionnaires completed, 3) frequency of code status documentation in the health record, and 4) hospice enrollment for both the targeted and all metastatic populations. Results: A three month review revealed the ACP work within all metastatic populations at the ten sites. Targeted population totals showed continued increase in the percentages of patient ACP engagement at each site. For the practice as a whole, and the targeted population, 9-23% of patients have received an ACP counseling visit. There have been 149 completed Patient Values questionnaires. In the electronic health record, there are 2,233 (24%) patients who have a documented code status. A range of hospice enrollment from 8-28% in the targeted populations has continued to improve hospice length of stay. Conclusions: The patient is invited to explore their treatment options, their personal values and the completion of the advance directive documents. Truthful conversations are critical between patient and provider in order to create a meaningful treatment plan, and to allow the patient to gain understanding about their options. Early palliative care referrals are integrated into each session for symptom management through local partnerships with palliative care physicians. Education regarding life-sustaining interventions help the patient determine their choices for medical care. Having ACP counseling is important at any stage of health and particularly within life-limiting disease.
Implementation of NCCN palliative care guidelines by member institutions.
Authors: Portman Diane G. , Albizu-Rivera Alexandra , Thirlwell Sarah , Codada Shirley N. , Donovan Kristine A. 
Published: February 2017

15 Background: To promote access to quality, evidence-based palliative care (PC) and help cancer patients experience the best quality of life possible throughout the illness trajectory, the National Comprehensive Cancer Network (NCCN) has developed PC guidelines to guide symptom screening, assessment, PC interventions, and reassessment by the oncology team. We sought to evaluate use of the guidelines among NCCN member institutions. Methods: In April and May 2014 an invitation and reminders to participate in an online survey were sent electronically to NCCN PC guidelines panel members. If a panel member did not reply, individuals involved in the provision of PC at the same institution were approached. Results: Responses were received from 21 (84%) of the 25 member institutions. All of the institutions report having an interdisciplinary team with PC expertise. Among respondents, 38% have an accredited/certified PC program and 52% have an institutional PC quality improvement program in place. Fifty-two percent submit data to the National Palliative Care Registry. Forty-three percent have guidelines or triggers in place for the use of PC services. Only 10% actively employ the NCCN guidelines to screen for PC needs or make PC referrals; the guidelines are more often used to guide patient assessment (38%) and clinical practice (43%). When asked to endorse other PC referral criteria, 76% indicated the discretion of the oncology provider(s) and 29% the National Consensus Project for Quality Palliative Care. Sixty-two percent agree providers concur on the elements of PC and 29% agree as to who should receive PC. Only 19% agree early integration of PC should occur for all oncology patients and 43% agree PC referrals occur in a timely and efficient manner. The most frequently cited barriers to the provision of quality PC are: attitudes toward PC (71%), insufficient staffing (61%) and limited financial resources (57%). Conclusions: Implementation of the guidelines at NCCN member institutions is incomplete. There appears to be a lack of consensus about when and for whom PC should be provided. Future research should be designed to enhance understanding of the barriers to care and improve implementation of the guidelines.
A randomized, double-blind trial evaluating the palliative benefit of either continuing pamidronate or switching to zoledronate in patients with high-risk bone metastases from breast cancer (The Odyssey Study).
Authors: Jacobs Carmel Maree , Kuchuk Iryna , Smith Stephanie , Mazzarello Sasha , Vandermeer Lisa , Bouganim Nathan , Dent Susan , Gertler Stan Z. , Verma Shailendra , Young Vince , Song Xinni , Simos Demetrios , Dranitsaris George , Cella David , Clemons Mark 
Published: February 2017

155 Background: Questions remain around the optimal use of bone-targeted agents (BTA) in patients with bone metastases (BM) from breast cancer (BC). In Canada pamidronate (PAM) is the most commonly used BTA in BC.We explored whether a switch to a more potent BTA, like zoledronic acid (ZA), in patients who remain at high risk of skeletal related events (SREs) despite PAM use is associated with significant palliative benefit. Methods: BC patients with high risk BM (prior SRE, bone progression, bone pain or levels of bone turnover marker serum C-telopeptide (sCTX) >400ng/L) despite >3 months of PAM use were eligible. Patients were randomized in a double–blind manner to either switch to ZA or continue on PAM every 4 weeks for 12 weeks. Primary outcome was the proportion of patients achieving a fall in sCTX at 12 weeks. Secondary outcomes were pain control (BPI and FACT-BP) and toxicity. Results 73 patients completed the study. Median age 61 years (range 37 – 87), prior duration of PAM use 10 months (range 3 – 118). sCTX levels for all patients at baseline, 372+/- 471, week 12, 209 +/-290. Proportion of patients achieving a fall in sCTX from week 0 to week 12, 26/31 (84%) in ZA arm, 17/30 (57%) in PA arm, p=0.0262. Two patients were unable to complete the study due to deterioration in renal function (both receiving PAM), four due to progressive disease (two receiving ZA, two PAM), two patients chose to discontinue the study before completion (both receiving ZA). Four patients (5%) had SRE’s during the study, two receiving ZA, two receiving PAM. Quality of life and pain analysis shows no difference between week 0 and week 12 scores in either arm. Toxicity was predominantly grade 1 and 2, numerically there were more adverse effects in the ZA arm than PAM. Conclusion Switching patients with high risk BM from PAM to ZA leads to a reduction in sCTX levels but may be associated with more toxicity. Quality of life and pain scores were similar between the two treatments. While the literature suggests that a reduction in sCTX may correlate with reduced rate of SREs, given the lack of symptom improvement a switching strategy cannot be recommended. NCT01907880 Clinical trial information: NCT01907880.
Coping with cancer treatment-related financial burden.
Authors: Nipp Ryan David , Zullig Leah L. , Samsa Gregory , Peppercorn Jeffrey M. , Schrag Deborah , Taylor Donald H. , Abernethy Amy Pickar , Zafar Yousuf 
Published: February 2017

161 Background: Growing evidence suggests that financial distress is a side effect of cancer care needing attention. Little is known about how patients cope with treatment-related financial distress. This study describes how patients with cancer cope with treatment-related costs and identifies those at greatest risk for using potentially harmful cost-coping strategies. Methods: Eligible patients for this cross-sectional, survey study were adults being treated for solid malignancies enrolled June 2010 to May 2011 in a national copay assistance program. Coping strategies were grouped as lifestyle-altering or care-altering. Descriptive statistics and analysis of variance assessed coping strategies and relationships between covariates. Results: Among 174 participants, 89% used at least one lifestyle-altering strategy to cope with costs, while 39% used a care-altering strategy. Most common care-altering coping strategies included: not filling a prescription (28%); and taking less medication than prescribed (23%). Lifestyle-altering strategies included: spending less on leisure activities (77%); spending less on basics (57%); borrowing money (54%); and spending savings (50%). The mean number of coping strategies was higher for patients < 65 than for those ≥ 65 (Table). Lower-income patients used more care-altering strategies than higher-income patients. Patients with more education and shorter duration of chemotherapy adopted more lifestyle-altering strategies than their counterparts. Conclusions: Patients were generally more likely to use lifestyle-altering approaches to cope with treatment-related financial burden, but more than one-third adopted care-altering strategies. Younger patients and those with lower incomes were more likely to alter their care. Screening for and anticipating potentially harmful cost-coping behavior in the oncology clinic is important to reduce patient distress and promote optimal care. [Table: see text]
The conversion ratio for opioid rotation from hydrocodone to other strong opioids in cancer patients.
Authors: Reddy Akhila Sunkepally , Yennu Sriram , Wu Jimin , Liu Diane , Reddy Suresh K. , De la Cruz Maxine , Bruera Eduardo 
Published: February 2017

164 Background: Cancer pain is initially treated with intermediate strength analgesics such as hydrocodone and subsequently escalated to stronger opioids. There are no studies on the process of opioid rotation (OR) from hydrocodone to strong opioids in cancer patients. Our aim was to determine the conversion ratio (CR) for OR from hydrocodone to morphine equivalent daily dose (MEDD) in cancer outpatients. Methods: We reviewed records of 3,144 consecutive patient visits at our Supportive Care Center in 2011-12 for OR from hydrocodone to stronger opioids. Data regarding demographics, Edmonton Symptom Assessment Scale (ESAS), and MEDD were collected in patients who returned for follow up within 6 weeks. Linear regression analysis was used to estimate the CR between hydrocodone and MEDD. Successful OR was defined as 2-point or 30% reduction in the pain score and continuation of the new opioid at follow up. Results: 170/3,144 patients underwent OR from hydrocodone to stronger opioid. 72% were white, 56% male, and 81% had advanced cancer. The median time between OR and follow up was 21 days. 53% had a successful OR with significant improvement in the ESAS pain and symptom distress scores. In 100 patients with complete OR and no worsening of pain at follow up, the median CR (Q1-Q3) from hydrocodone to MEDD was 1.5 (0.9-2) and hydrocodone dose to MEDD correlation was.52 (P<0.0001). The correlation of CR with hydrocodone dose was -0.52 (P<0.0001). The median CR of hydrocodone to MEDD was 2 in patients receiving < 40mg of hydrocodone/day and 1 in patients receiving ≥ 40mg of hydrocodone/day (P<0.0001). The median conversion ratio of hydrocodone to morphine was 1.5 (n=44) and hydrocodone to oxycodone was 0.9 (n=24). Conclusions: Hydrocodone is 1.5-fold stronger than Morphine. The median conversion ratio from hydrocodone to MEDD varied according to hydrocodone dose/day. [Table: see text]
A nomogram for predicting serious complications in patients with solid tumors and apparently stable febrile neutropenia: Prospective data on 781 consecutive episodes from the FINITE study.
Authors: Ghanem Ismael , Antonio Rebollo Maite , Garrido Marcelo , Martinez Jeronimo , Font Carme , Ramchandani Avinash , Biosca Merce , Beato Carmen , Martinez de Castro Eva , Castanon Eduardo , Echaburu Juan Virizuela , Espinosa Javier , Sevillano Elena , Aragon Manrique Isabel , Cardona Merce , Mondejar Rebeca , Baron Francisco , Acevedo Francisco , Jiménez-Fonseca Paula , Carmona Bayonas Alberto 
Published: February 2017

165 Background: An accurate estimate of the likelihood of serious complications in patients with otherwise apparently stable febrile neutropenia (FN) may assist in decision-making regarding individualized therapy. Our group has developed a prognostic score for predicting complications in patients with solid tumors and apparently stable episodes called CISNE (Clinical Index for Stable Febrile Neutropenia). The purpose of this study is to present a nomogram based on the previously mentioned index in a broader dataset of patients. Methods: FINITE is a prospective and multicenter study which aims to investigate prognostic factors and outcomes of FN episodes with clinical stability at first assessment, defined as events without acute organ dysfunction, vital signs abnormalities or major infections. We performed a nomogram based on the CISNE score which includes the following prognostic variables: ECOG PS≥2, chronic obstructive pulmonary disease, cardiovascular disease, mucositis NCI grade ≥2, monocytes <200/mm3 and stress-induced hyperglycemia. A calibration plot was used to analyze the accuracy of this multivariate nomogram. Results: From October 2012 to December 2013, 781 patients with apparently stable FN were recruited in 21 Spanish hospitals. The rate of infection-related complications and death was 15.6% (95% confidence interval [CI], 12.9-18.6%) and 1.7% (95% CI, 0.98%-3.01%). A nomogram was designed according to the CISNE score. The area under the ROC curve was 0.836 (95% CI, 0.808-0.861). The observed and predicted probabilities also matched closely. Conclusions: Our group has developed a user-friendly nomogram for predicting complications in patients with apparently stable FN. This nomogram may be particularly useful to prevent premature discharges of cancer patients starting inpatient management.
How to create a successful cancer self-management intervention: Development, evaluation, and lessons learned.
Authors: Goldberg Jessica , Hinchey Jenna , Feder Shelli , Schulman-Green Dena 
Published: February 2017

168 Background: Cancer self-management (SM) is individuals’ engagement in tasks related to the medical, physical, spiritual, and emotional management of cancer. Reports of SM interventions often focus on efficacy and do not detail processes of development and evaluation. We delineate our creation of a patient-oriented and informed cancer SM intervention, Managing Cancer Care: A Personal Guide (MCC), and share lessons learned to improve intervention efficacy and fidelity. Methods: We developed and evaluated MCC in 5 stages: needs assessment interviews (n=25); development of MCC; focus group (n=6); pilot testing with metastatic breast cancer patients (n=23); and population testing with non-metastatic breast cancer patients (n=110). We performed content analysis on qualitative data and used descriptive statistics to analyze module ratings and frequency of use in the pilot and population tests. Results: We identified cancer SM practices, preferences, facilitators, and barriers, and designed MCC based on interview data, related literature, and SM theory. The MCC prototypeconsisted of 7 magazine-style modules designed to be user-friendly, concise, and personalized. Although well-received, we made substantial changes based on focus group data, with additional revisions after the pilot test. Module ratings and frequency of use differed between pilot and population samples. Among metastatic patients, median ratings (1-10, low/high) for MCC as a whole on both content and format were 8 (range 2-10). The most popular module was Care Options, which tied with Managing Transitions as most frequently used. Among non-metastatic patients, median ratings were 8 (range 1-10) and 9 (range 2-10) on content and format, with the Managing Your Symptoms module being most popular and most frequently used. Conclusions: Data from our metastatic and non-metastatic samples suggest differing SM priorities. Lessons learned in creating patient-oriented cancer SM interventions include acknowledging that there are no “one size fits all” solutions, resisting assumptions about reception of potentially emotional content, maintaining flexibility, and negotiating the tension between research and real world settings.