bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical and health care setting of patients admitted at Pain Control Center Hospice of Solofra: A feasibility model of end-of-life care in the Avellino province of Italy.
Authors: Genua Geppino , Fasano Carmela , Rizzo Luisa M. , Strollo A. M. , De Vinco Elena , Landolfi Vincenzo , Altieri Elena , Ferrante Mario Nicola Vittorio , Canzanella Sergio , Servillo Giuseppe , Genua Lucia , Zampi Maddalena , D'Onofrio Gaetano 
Published: February 2017

59 Background: The Pain Control Center Hospice of Solofra (Italy) is managed with a mixed public / private, the first experience in the Campania region.We have evaluated the treatment procedures and the clinical outcome to make a comparison by between 123 evaluable patients in palliative care in 2015 and 232 evaluable patients in the biennium 2012-2014. Methods: The following characteristics: patient gender, mean hospitalization time, differentiation between cancer and non cancer patients, medical weapon use, venous access type, enteral and parenteral feeding, pain killer use,Karnofsky scale. Results: the average age is nearly overlapping being 70.5 yr vs 70.69 yr; average length of stay in hospice 24.33 days vs. 27.52 days; 79.67% had cancer vs 73.70%, while the non-cancer 20.32% vs 26.30%; 55.26% died in hospice vs 71.98%, while 44.7% were discharged home vs 24.56%; the performance status according to Karnofsky scale before admission to hospice 23.1% had index rating (%)- 50, 10.56 -40, 52.03%-30, 35.7%-20, 23.1%-10. 8.9% had ostomy vs 13.79%; 4.4% were carriers of PEG vs 6.3%; the central venous access already implanted at admission in 32.52% vs 26.72%; enteral feeding was administered in 23.7% vs 13.79% and parenteral feeding in 52.84% vs 46.98%; analgesic therapy with more opiates was already present on admission in 48.78% vs 40.94% with prevalence of trans TD formulations. Analgesic therapy was administered during the hospitalization in 66.66% vs 81.89%. 14.28% of cancer patients in 2015 have received morphine treatment vs 15.3%, 22.11% oxycodone / naloxone vs 19%, 58.16% trans-dermal fentanyl vs. 34%, 14.7% have supplements onset fentanyl, 2.4% with tapentadol vs na, 15.30% tramadol vs 9%, 4.2% codeine vs 15.3%. Conclusions: This report is a feasibility model of end of life-care in the Avellino province submitted to the public administrative control with the private organization supporting House Hospital Onlus. The present study shows gradual improvement of the knowledge of palliative care by the family doctors and the population of a territory with peculiar topography and induces public health authority to improve the care offered.
Breakthrough cancer pain (BTcP) and quality-of-life outcomes.
Authors: Stati Valeria , Spinelli Gian Paolo , Gozzi Elisa , Rossi Belardino , Tomao Silverio 
Published: February 2017

61 Background: Breakthrough cancer pain (BTcP) is frequent in patients with advance solid tumors and is always associated with worsening of the quality of life (QoL). There are few studies in the literature on the effect of BTcP treatment on QoL. The aim of this analysis was to provide a qualitative evaluation of the effect of BTcP therapies considering different fentanyl formulation(nasal spray, lollipop or buccal tablets) on the QoL of treated patients. Methods: In our study, we enrolled patients with different advanced solid cancer treated with active and/or palliative therapies. All patients included have a baseline analgesis therapy and showed frequent BTcP episodes during the day. The patients were evaluated with a simultaneous care control (medical oncologist, palliativist, psychologist and nurse) every week for four consecutively weeks after initiating treatment with BtcP medicaments. A questionary about BtcP and QoL evaluation (QoL-BTcP scale) was administered. It was also completed by an interview during periodic visit. The main parameters investigated were frequency of BTcP, cancer pain value (NRSscale), fentanyl formulation for BTcP (nasal spray, lollipop or buccal tablets), time of onset of cancer pain relief and adverse events correlated with use of BTcP medicaments. At each simultaneuous care evaluation the authors evaluated the impact of BTcP medicaments on psychologic aspects using a validated Anxiety, Depression and health status Scale integrated to QoL-BTcP questionary (QoL-BTcP scale). Results: A total of 35 patients with > 2 BTcP episodes/die were enrolled (50% from 2 to 4 episodes, 45% from 5 to 6 episodes and 5% for those patients with more than 6 episodes). QoL-BTcP scores showed significant improvement in the QoL in terms of depression and other psychologic aspects in the first two subgroups (from 2 to 6BTcP episodes). The QoL-BTcP scale was worse in more depressed patients and in those patients at the end of life. Conclusions: QoL-BTcP scale is a reliable and valid instrument for measuring QoL correlated to efficacy and tolerability of BTcP drugs. Results provide some suggestions for the development of programs to evaluate QoL in patient with cancer pain and implement BTcP interventions among cancer survivors.
Association between tobacco use, pain expression, and maladaptive coping among patients with advanced cancer.
Authors: Dev Rony , Kim Yu Jung , Reddy Akhila Sunkepally , Hui David , Tanco Kimberson Cochien , Liu Diane D , Park Minjeong , Williams Janet L. , Carmack Cindy L. , Bruera Eduardo 
Published: February 2017

65 Background: Cancer patients who smoke have been reported to have higher pain expression and increased risk for opioid abuse. The purpose of our study is to evaluate the association between tobacco use, symptom expression, and maladaptive coping in advanced cancer patients. Methods: We prospectively enrolled advanced cancer patients evaluated in an outpatient Supportive Care Center and collected data on patient demographics, cancer diagnosis, morphine equivalent daily dose (MEDD), cigarette smoking status using Behavioral Risk Factor Surveillance System, symptom expression as measured by Edmonton Symptom Assessment Scale, Cut down/Annoyed/Guilty/Eye opener (CAGE alcoholism questionnaire), short form Screener and Opioid Assessment for Patients with Pain (SOAP-SF) survey, and Brief COPE Questionnaire. Results: Among399 patients, 195 (49%) were never smokers, 158 (40%) former smokers, and 46 (11%) current smokers. The most common malignancies were gastrointestinal (21.1%) and breast (19.5%). Never smokers were more likely to be female (p = 0.005). Current smokers expressed significantly higher pain scores at consultation than former or never smokers [median 7 vs. 6 vs. 5, respectively (p = 0.015)], increased MEDD (median 90 vs. 60 vs. 50, p = 0.002), and more likely to screen CAGE positive (33% vs. 24% vs. 8.7%, p < 0.0001). Compared with former and never smokers, current smokers were significantly more likely to cope with substance use (p = 0.02), denial (p = 0.007), and self-blame (< 0.0001), while both current and former smokers significantly more likely to use venting (p = 0.04). In addition, current smokers compared with former and never smokers were significantly more likely screen positive (≥ 4) on the SOAP-SF survey (74% vs. 13% vs. 9.3%, p = < 0.0001) and clinicians rated patients to be at higher risk for maladaptive coping (6.5% vs 2.5% vs. 1.5%, p = 0.003). Conclusions: In advanced cancer, current and former smokers were significantly more likely to have higher pain expression, CAGE positivity, and increased MEDD at consultation. In addition, a history of current or past tobacco use in advanced cancer patients was associated with increased risk of maladaptive coping.
Assessment tools for palliative care.
Authors: Isenberg Sarina , Aslakson Rebecca , Dy Sydney Morss , Wilson Renee , Waldfogel Julie , Zhang Allen , Blair Alex B. , Robinson Karen 
Published: February 2017

66 Background: Recent reviews have not comprehensively addressed palliative care (PC) assessment tools. This project summarizes the extent of evidence about PC assessment tools for patients and families, and how tools have been used for clinical care, quality indicators, and evaluation of interventions. Methods: We searched MEDLINE, CINAHL, and Cochrane Database of Systematic Reviews for systematic reviews of assessment tools for PC, from January 2007 to March 2016. We searched the grey literature for domains without systematic reviews, and for domains with systematic reviews > three years old. Paired investigators independently screened search results and grey literature to determine eligibility, and assessed risk of bias of systematic reviews. The team selected the most recent and highest-quality systematic reviews for each domain. One investigator abstracted information, and a second investigator checked the information. Results: Using the National Consensus Project Palliative Care Guidelines domains, we included nine systematic reviews with 167 tools, and six tools from grey literature. Most tools were in physical, psychological, psychiatric, and social aspects of care, care at the end of life, and tools that cross domains (quality of life and caregiver-reported experience). Only two tools directly addressed spiritual aspects and none addressed cultural or patient-reported experience. Internal consistency reliability was evaluated for almost all tools; most reported construct validity; and few reported responsiveness (sensitivity to change). Few studies evaluated the use of assessment tools in quality indicators or clinical practice. A systematic review of 38 PC interventions and the assessment tools used found that at least 25 interventions included physical, psychosocial and psychiatric, and quality of life tools, but the tools varied extensively, and only nine included patient experience tools. Conclusions: Although assessment tools exist in many PC domains, tools are needed to assess spiritual and cultural aspects of care, and patient-reported experience. Research is needed concerning: tools in clinical practice and quality of care; comparison of existing tools; and evaluation and dissemination tools with evidence of responsiveness.
Changing the culture for psychosocial care: Does it need changing?
Authors: Carmack Cindy L. , Parker Patricia A. , Lambert Daphine , Ann-Yi Sujin , Valentine Alan D. , Fossella Frank V. , Bruera Eduardo , Williams Janet L. , Cohen Lorenzo 
Published: February 2017

70 Background: National organizations recommend routine screening for psychosocial distress in cancer patients. American College of Surgeons (ACoS) Commission on Cancer mandates screening for accreditation with requirements for timing/method/tool for screening; assessment/referral; and documentation. Methods: MD Anderson routinely screens patients for distress with policies and algorithms for the process. We sought to enhance this standard process by incorporating a dedicated psychosocial liaison in the clinic to ensure screening based on NCCN guidelines, follow-up with patients at the medical visit, and clear documentation and referral per ACoS standards. This study compared the standard process to the enhanced process (which occurred in parallel) through a 6-month retrospective chart review of Thoracic Center patients identified as distressed by either process. Results: The enhanced process utilized the Distress Thermometer (DT) cut-off > 4 resulting in optimal specificity (.77) and sensitivity (.64) compared to the standard process using > 6 (specificity = .87; sensitivity = .34). In the enhanced process (N = 71), 99% were seen during the clinic visit, compared to 13% in the standard process (N = 92) (Fishers Exact; P < .0001). In the standard process, 18% were contacted by phone, 10% were seen later while in-patient, and 33% received a phone message; for 26%, no note was dictated. In the enhanced process, there were high rates of documentation of assessments of suicide (100%), depressive symptoms (100%) and anxiety symptoms (96%) compared to the standard process where documentation occurred less often (suicide 5%; depressive symptoms 11%; anxiety symptoms 11%) (Fishers Exact; all P’s < .0001). Conclusions: Results support the institution’s recent practice change to > 4 on the DT. The enhanced process utilizing a psychosocial liaison facilitates screening at the clinic visit and can support existing mental health providers who may have competing responsibilities. Findings also suggest having standards for distress documentation. Overall, the enhanced process fully meets ACoS standards in all required areas.
A comparison of patients with liver cancer receiving palliative care at two Veterans Affairs (VA) Medical Centers.
Authors: Lee Sarah , Wang Zhen , Kothadia Sejal , Wang Yucai , Olson Ellen , Park Yeun-Hee Anna , Klein David , Zhong Fengming , Chang Victor Tsu-Shih 
Published: February 2017

75 Background: Liver cancer is a leading cause of death. Lack of data exists on palliative care in this group, and care varies by location. We aim to determine if there are differences in palliative care for patients (pts) with liver cancer by VA site. Methods: In an IRB approved protocol, we reviewed medical records of pts at 2 VA medical centers (S1, S2) with liver cancer, who were seen by Palliative Care between 2006 and 2012. Veterans were compared by 1) demographics: Karnofsky performance status > 50 (KPS), marital status, DNR/DNI, 2) palliative intervention: goals of care discussion, referrals to psychology and PT/OT, and 3) outcomes: ED visit within 1 month (mo) of death, ED visit within 6 mo of death, ICU within 30 days of death, and hospice as site of death, time from diagnosis to palliative care, and time from DNR to death. Chi-square, Fisher’s Exact, and T-test were performed with Stata. Results: here were 82 men, 30 from S1 and 52 from S2, median age 61 (35-87) and 63 (54-88) yrs, respectively. Pts were Caucasian 30 (36%), African American 47 (57%), and other 5 (0.1%). Cancer stages were locoregional 15 (50%), metastatic 13 (43%), and unknown 2 (0.1%) at S1 and 28 (54%), 20 (38%), 5 (0.1%) at S2. Differences were seen in KPS > 50: (S1, S2) [10 (33%), 15(29%) p = 0.010], married: (S1, S2) [7 (23%), 24(46%) p = 0.024], DNR/DNI: (S1, S2) [19 (63%), 13(25%), p = 0.001]. Regarding palliative intervention: goals of care discussion (S1, S2) [26 (87%), 44 (85%), p = 0.044], referral to psych (S1, S2) [16 (53%), 42 (81%) p = 0.014], referral to PT/OT (S1, S2) [17 (57%), 15 (29%), p = 0.007]. Finally in regards to outcome: ED visit within 1 mo of death (S1, S2) [7 (23%), 31 (60%), p = 0.001], ED visit within 6 mos of death (S1, S2) [18 (56%), 35 (67%) p = 0.031], ICU within 30 days of death (S1, S2) [0 (0%), 9 (17%) p = 0.019}, and hospice as site of death (S1, S2) [19 (63%), 21 (40%), p < .0001]. Other key differences included median number of days from diagnosis to initial palliative care consult (S1, S2) [97, 39, p = 0.001] and median number of days from DNR to death (S1, S2) [33, 14, p = 0.001]. Conclusions: Results show there are site-specific differences between VA medical centers. These data may be important in the comparison of other centers and provide a baseline for future studies.
Using touch-based technology to screen patients in the ICU.
Authors: Zachariah Finly , Loscalzo Matthew J. , Sidhu Rupinder , Horak David , Buga Sorin 
Published: February 2017

76 Background: The intensive care unit (ICU) is associated with high mortality rates, significant costs, along with occasionally futile and non-indicated care. Surveys of patients indicate the majority wish to focus on comfort and being at home at the end of life as opposed to the aggressive interventions received in the hospital. Although a small percentage of patients may be awake, medical teams look to the families to provide the direction of care for a patient in the ICU. City of Hope National Medical Center has utilized tablet-based screening of caregivers for years, and now in conjunction with delirium screening has started to roll out tablet-based screening for patients who are awake and do not have delirium. Methods: In parallel with a task force working to assess and address delirium in the hospital, team members from the Department of Supportive Care Medicine and the ICU developed and tested a survey on a tablet-based screening platform. Awake patients are screened for delirium using the confusion assessment method (CAM-ICU). If patients are awake and have a “negative” CAM-ICU, they are provided a tablet to take a five question survey. The questions were written to the sixth grade language level, reviewed by the Patient and Family Advisory Council and non-ICU patients commented on comprehension and emotional response prior to implementation in the ICU. The questions covered topics including orientation, symptoms to be addressed and confidence level in communicating wishes and values. Results: We have successfully administered tablet-based screening for five patients in the ICU, including one on a ventilator with a tracheostomy. Responses are electronically sent to the medical team. By the time of the conference, we will have screened over 50 patients, including patients who are intubated. Conclusions: Assessment of patient wishes and values should be done far before a patient enters the ICU. Unfortunately this does not always occur. This tablet-based screening pilot was a test of concept for feasibility. Although not ideal, capturing a patient’s values and wishes in the ICU has the potential to further assure care plans are individualized, minimize unwanted treatment options and facilitate possible transitions and improved care.
Oncology massage impact on patient with cancer and caregiver self-reported symptoms as part of an integrative oncology program at a comprehensive cancer center.
Authors: Lopez Gabriel , Milbury Kathrin , Spelman Amy , Wei Qi , Sumler Pamela A , Beinhorn Curtiss M , Bruera Eduardo , Cohen Lorenzo 
Published: February 2017

79 Background: Massage as a manual therapy has shown benefit for symptomatic relief in patients with cancer and their caregivers. We explored the impact of a single massage session on self-reported symptoms in an outpatient clinic at a comprehensive cancer center. Methods: Patients and caregivers received oncology massage treatments (30 or 60-min duration) at our Integrative Medicine Center outpatient clinic from Sep 2012-Jan 2015. Participants completed a modified Edmonton Symptom Assessment Scale (ESAS; 0-10 scale, 10 most severe) pre- and post-massage. ESAS individual items and subscales scores of Physical Distress (PHS), Psychological Distress (PSS), and Global Distress (GSD) were analyzed. We used paired t-tests with a Bonferroni correction (i.e., p < .001) to examine pre/post massage self-reported symptoms. Results: Initial massage visits for 164 patients and 39 caregivers were analyzed. Highest symptoms burden (means) at baseline for patients were Sleep 3.93, Fatigue 3.70, and poor sense of Well-Being 3.62; for caregivers Distress 4.14, Sadness 3.43, and Sleep 3.21. Although patients reported significantly more physical symptoms (F = 27.56, P < .0001) compared to caregivers at baseline, groups did not differ in regard to psychological symptom burden (P = .75). Massage therapy was associated with significant improvements in PHS, PSS, and GSD for both patients and caregivers at P < .0001. Including participants with symptom report ≥ 1, massage resulted in a clinically significant improvement (reduction ≥ 1) in pain, fatigue, sleep, distress, dry mouth, sadness, numbness, anxiety, wellbeing for patients; pain, fatigue, distress, sadness, numbness, anxiety, wellbeing for caregivers. Regarding massage duration, there were no significant effects for 30 vs 60-min duration on pre/post ESAS difference scores. Conclusions: A single 30- or 60-minute massage session resulted in acute relief of self-reported symptoms in patients and caregivers. Further study is warranted regarding optimal massage dose and frequency.
Effect of Edmonton Symptom Assessment Scale (ESAS) on symptom data collection in a radiation oncology department.
Authors: Savla Bansi , Venkat Puja , Yu Michael 
Published: February 2017

83 Background: ESAS has been used to examine quality of life and symptom burden of patients undergoing cancer treatment. The purpose of this study is to examine attitudes towards ESAS among patients in a Radiation Oncology clinic in conjunction with the perspective of cancer care professionals, to establish ideal implementation of this tool to improve patient care. Methods: Routine use of ESAS in a single Radiation Oncology Department was initiated in July 2015. Six months after implementation, an anonymous, electronic survey was administered to 50 healthcare providers within this department, including attending physicians, resident physicians, advanced practice nurses, physician assistants, and registered nurses. The survey collected information regarding the value of ESAS with regards to patient care, the numerical value at which an intervention is made, which clinical interventions had been implemented due to patient-reported scores on ESAS, which patient populations benefit from ESAS administration, and how frequently ESAS should be administered. Closed and open questions were included. Results: Out of 50 providers, 36 completed the survey. Of these, 31 reported finding ESAS useful. The most common intervention was questioning the patient further about symptoms (29/36.) ESAS data are being reviewed by clinical teams and stored as part of the patient’s medical record in order to compile longitudinal data. An anonymous paper survey is currently being administered to 50 patients at the end of their radiation treatment or at their first follow-up. The survey will collect information about how well symptoms are being communicated with the clinical team, if symptoms should be added to ESAS, how often ESAS should be administered, which specific clinical interventions were provided due to ESAS, and if ESAS improved the overall patient experience. Conclusions: Our survey from the clinical team supports that ESAS is a useful modality to assess patient symptoms and to improve management for patient symptoms effectively. Our ongoing patient survey will validate these findings. These two surveys will be used to improve systematic collection of symptom data for radiation oncology patients.