bluuebunny/crossref_metadata_2025_split huggingface dataset:
Long-term efficacy and safety of duloxetine in the management of painful chemotherapy induced peripheral neuropathy.
Authors: Ro Sang Mi , Woo In Sook 
Published: November 2017

236 Background: Accordingly, Quality of life in the survivorship of patients with cancer is becoming one of the important issues with a development of systemic anticancer treatment. About 40% of the patients who receive chemotherapeutic agents which have neuropathic potential suffer from painful CIPN. Various approaches to relieve the pain associated with CIPN have been attempted in clinical practice. Previously duloxetine, a dual reuptake inhibitor of serotonin and norepinephrine, has been reported to reduce painful CIPN when administered for 5 weeks. We retrospectively investigated the effect of duloxetine on the pain associated with CIPN over a prolonged period of administration. Methods: Between December 2014 and December 2016, patients with advanced cancer who complained of CIPN during or after systemic chemotherapy were eligible. Initially, 30 mg of duloxetine was administered daily for the first week and 60 mg daily was administered from the second week thereafter. The severity of pain was evaluated using a numerical rating scale from 0 to 10. Study follow-up was performed at regular visits according to the chemotherapy schedule or at the time of evaluation of disease status in the patients who completed systemic chemotherapy. However, the patients were allowed to visit whenever needed. Results: Twenty-seven patients were evaluable, the median age was 64 years (range, 23-83 years), and 11 patients were male and 16 patients were female. Twenty-four of the 27 patients received neurotoxic chemotherapeutic agents such as cisplatin, oxaliplatin, taxane and vinca alkaloid. Patients receiving duloxetine showed a significant reduction in the pain intensity from baseline and the mean decrease in the average pain score was 2.85 (95% CI 2.26-3.44, P < 0.001). Twenty-five (92.5%) of the 27 patients showed decreased pain after the use of duloxetine. Mean duration of treatment was 29 weeks (range, 1~130 weeks). Median duration of response was 19 weeks (range, 4~99 weeks). Treatment-related adverse events were nausea (17.2%), vomiting (3.4%) and dizziness (6.8%). Conclusions: Duloxetine demonstrated a durable efficacy and tolerability for painful CIPN in patients with advanced cancer.
Health-related quality of life in patients with advanced colorectal cancer treated with dose reduced capecitabine.
Authors: Breadner Daniel Adam , Welch Stephen , Cripps M. Christine , Jonker Derek J. , Lam Wendy , Klimo Paul , Biagi James Joseph , O'Connell Anne , Whiston Frances , Stitt Larry , Vincent Mark David 
Published: November 2017

237 Background: The goal of palliative chemotherapy is to prolong survival and decrease the symptomatic disease burden while minimizing treatment toxicities to preserve or improve quality of life. We recently reported a trial of dose reduced capecitabine in elderly or frail patients with advanced colorectal cancer, demonstrating that dose reduced capecitabine was a safe and efficacious treatment option. We herein report the health related quality of life (HRQoL) outcomes for the trial. Methods: A single arm multi-centered phase I/II trial of dose reduced capecitabine assessed capecitabine in 221 patients in at least one of the following subgroups: Age > 65, ECOG-PS ≥1, elevated LDH, and prior pelvic RT. Capecitabine was given at 2000 mg/m2 days 1-14 q21 days; or 1500 mg/m2 for patients with prior pelvic RT, as determined in the phase I portion of the study. Phase II participant (182 pts) were asked to complete FACT-G questionnaires at enrollment, after each cycle of capecitabine and once after cessation of the study drug, if possible. Results: 157 pts completed a baseline questionnaire (86%), and 137 pts (75%) completed a baseline and at least one subsequent questionnaire. The mean baseline score was 81.6, out of a possible 108. The mean score peaked at 92 after cycle 10. The mean change from baseline was always positive, with the maximum change (4.0), occurring after cycle 12. The number of patients who achieved the minimal important difference, a meaningful improvement in HRQoL, ranged from 30% to 45% during treatment cylces. The differences in HRQoL between capecitabine doses were minimal and did not reach significance. Patients who did not achieve disease control also reported an improvement in mean score from baseline (+3.9) after cycle 2. Changes in subscale mean scores for physical and social/family wellbeing were minimal (-1.2 to +0.5) while emotion and function subscale mean scores never decreased with the peak subscale change from baseline being +3.5. Conclusions: HRQoL improved on capecitabine therapy at 2000 or 1500 mg/m2 daily, further supporting its use in elderly and less fit patients with advanced colorectal cancer.
Frequency of concomitant use of opioids and psychoactive medications among cancer patients referred to outpatient palliative care at a comprehensive cancer center.
Authors: Azhar Ahsan , Haider Ali , Wong Angelique , Cerana Maria Agustina , Adabala Madhuri , Balankari Vishidha Reddy , Liu Diane D , Dibaj Seyedeh , Williams Janet L. , Bruera Eduardo 
Published: November 2017

240 Background: There are potential severe effects when patients taking opioids receive other psychoactive medications. However, such combinations are sometimes necessary in palliative care. The purpose of this study was to determine the frequency of concomitant use of opioids + psychoactive medications in cancer patients referred to our outpatient palliative care center. Methods: Retrospective data obtained from consecutive consults was analyzed to determine the frequency of patients on opioids alone versus concomitant opioids + psychoactive medications at first presentation to our clinic. Association of type of medication with demographics and baseline characteristics was evaluated by Wilcoxon rank sum test for continuous variables and Chi-square (Fisher's exact) test for categorical variables. Results: Among 541 consecutive consult visits, 365 (67%) patients were taking opioids at the time of referral to our clinic: 209 (57%) were on opioids alone while 156 (43%) were on concomitant opioids + psychoactive medications [69 (44%) were on Opioid + Benzodiazepine, 46 (30%) were Opioid + Antidepressants, 41(26%) were on both). Patients in the concomitant groups were on higher Morphine Equivalent Daily Dose (MEDD, p = 0.007), had higher Edmonton Symptom Assessment Scores (ESAS) for pain (p = 0.017), anxiety (p < 0.001), depression (p < 0.001) and spiritual pain (p = 0.03). Conclusions: A large proportion (156, 43%) of cancer patients referred to outpatient palliative care was on concomitant opioids + psychoactive medications. These patients were on higher doses of opioids with higher levels of pain and psycho-social distress at the time of first presentation. Further studies are required to better understand the clinical implications of concomitant use of opioids + psychoactive medications in such patients.
Cannabis use in palliative care: The prevalence and clinical characteristics.
Authors: Chang Young Doo , Smith Joshua S. , Oberoi-Jassal Ritika , Desai Vijay , Winn Stephanie L , Portman Diane , Donovan Kristine A. 
Published: November 2017

245 Background: Cannabis has growing attention in palliative care, been used for some cancer related symptom burden, but limited data in terms of prevalence in palliative care setting and clinical characteristics with using it. Purpose: To identify the prevalence of positive rate of cannabis metabolite on urine drug sample (UDS) and compare clinical characteristics focused on symptoms burden on Edmonton Symptom Assessment Scale (ESAS) on the same day of UDS. Methods: We conducted retrospective medical records review of 919 consecutive supportive care clinic patients who were seen at a National Cancer Institute center during a 12-month period between 7/01/2015 to 6/30/2016. Results: 531 out of 919 patients were excluded because UDS was not ordered: either patients were established or had low risk of substance abuse by clinicians’ judgement. 2 patients did not complete ESAS on same day of UDS. 137 patients were excluded because of missing UDS results as well. Finally, 249 out of 919 patients were included for data analysis with their UDS and ESAS at same day of visit. 54 patients were positive for cannabis metabolite (THC: tetrahydrocannabinol) on UDS (22%). We found that positive cannabis group was younger (Mean age 56.1 vs 48.8, p-Value .001), reported higher score of total ESAS (Mean 45.5 vs 38.9, p-value 0.023), pain (Mean 6.13 vs 4.99, p-Value 0.007), and insomnia (6.04 vs 4.44, p-Value 0.001). In addition, positive cannabis group reported poorer overall wellbeing (5.43 vs 4.56, p-Value 0.015) and spiritual wellbeing (6.04 vs 4.44, p Value 0.040) compared to negative cannabis group. Conclusions: The positive results of cannabis on UDS may be a marker of greater symptom burden, in particular, pain, insomnia and poorer overall and spiritual wellbeing as assessed by ESAS patient’s self-reporting.
Palliation of urinary obstruction from advanced prostate cancer with SBRT.
Authors: Boreta Lauren , Raleigh David Ronan , Roach Mack 
Published: November 2017

246 Background: In patients with advanced prostate cancer (PCa), urinary obstruction (UO) can lead to urinary retention requiring indwelling or suprapubic catheterization, which negatively impacts quality of life. Palliative options for UO from advanced PCa include surgical and medical treatment. Surgical intervention, including prostatectomy, pelvic exenteration and TURP, may confer undue risk to patients with advanced disease. Medical palliation may require months to take effect. Stereotactic Body Radiotherapy (SBRT) is a non-invasive technique that delivers high-dose and highly conformal radiation in ≤5 fractions, often used to treat PCa and metastatic disease. Here, we reviewed the utility of SBRT to treat UO from advanced PCa. Methods: A retrospective review of patients undergoing SBRT for UO was completed at a single institution between 2011 and 2017. Stage, PSA at diagnosis and time of treatment were recorded. Assessment of urinary function by IPSS/SHIM and documentation of catheterization were reviewed at consultation andsubsequent follow-up. Results: A total of 3 patients were treated with SBRT to the prostate for the palliation of urinary obstruction. Patient ages were 67, 57 and 52 years, and all had high risk, stage IV disease, Gleason 4+4 or 4+5, T3 or T4, with regional nodal, bony or visceral metastases. All patients required indwelling catheterization for an average 4 months prior to SBRT. Two patients were treated with whole pelvis irradiation after SBRT. In those who received subsequent pelvic irradiation, the SBRT doses to the prostate were 19 Gy in 2 fractions. The patient treated with SBRT monotherapy received 38 Gy in 4 fractions. Catheters were successfully removed in all 3 patients, one at the completion of radiation, and the others within 4 weeks of completion. With follow-up ranging from 1.2 to 6 years, no patients required re-catheterization, and there were no reports of grade ≥3 acute or long-term toxicity. Conclusions: SBRT is an effective treatment to palliate UO from locally advanced PCa, leading to removal of urinary catheters and presumed improved in quality of life. Further investigation is required to establish the optimal dose and fractionation of palliative SBRT for UO from PCa.
Comparing physician and nurse ECOG performance status ratings as predictors of clinical outcomes in cancer patients.
Authors: Neeman Elad , Gresham Gillian , Hendifar Andrew Eugene , Tuli Richard , Figlin Robert A. , Shinde Arvind Manohar 
Published: November 2017

248 Background: The Eastern Cooperative Oncology Group Performance Status (ECOG) scale is commonly used in the clinical and research setting, and has been shown to correlate with cancer morbidity, mortality, and tolerance to chemotherapy. ECOG is frequently rated by physicians (MDs) and nurses (RNs), and MD-RN ECOG score agreement varies widely in the literature. It remains unclear whether MD and RN ECOG scores differ in their ability to predict clinical outcomes. Methods: As part of a quality initiative at Cedars-Sinai Cancer Center, oncologists and chemotherapy RNs independently scored ECOGs for a random sample of 309 patients with various solid malignancies, on one or more visits, for a total of 506 pairs of ECOG scores. MD/RN interrater agreement was evaluated using the Cohen's kappa coefficient. Logistic regression models were fit to evaluate the ability of RN and MD ECOG scores, as well as the RN-MD score difference, to predict the occurrence of chemotoxicity (CTCAE v4, grade≳3) and hospitalizations within 1 month from ECOG ratings as well as 6-month mortality/hospice referrals. Results: The agreement among 506 ECOG MD/RN pairs was 71% (Kappa = 0.485, p < 0.0001). RN ECOGs had a stronger odds ratio (OR) for 6-month mortality/hospice (OR = 3.55, CI 2.2-5.7) compared to MD ECOGs (OR = 2.99, CI 1.67-5.3). RN ECOG scores also significantly correlated with one-month chemotoxicity (OR = 1.39, CI 1.02-1.90), but MD ECOGs did not. Both MD and RN ECOG scores did not significantly correlate with 1-month hospitalizations. The magnitude of RN to MD ECOG score difference was also positively associated with 6-month mortality/hospice (OR = 3.42, CI 1.87-6.3), but not with 1-month hospitalization or chemotoxicity. Conclusions: Our findings suggest that RN-rated ECOGs may be stronger predictors of chemotoxicity and 6-month mortality/hospice compared to MD ECOGs. Furthermore, the magnitude of difference between ECOG MD and RN ratings was associated with increased mortality/hospice rates, specifically when the MD rating was “healthier” than that of the RN. As ECOG scores are frequently used for prognostication and to inform treatment decisions, ECOG scoring by RNs may result in additional clinical benefit.
Evaluating the role of massage therapy on patient caregivers in a comprehensive community cancer center.
Authors: Chandra Abhinav Binod , Alvarez Angelic , Sweigart Mary , Turpin Kathleen M , Kumar Vivek 
Published: November 2017

25 Background: Cancer patients and their families undergo a lot of emotional and psychological turmoil during their cancer journey. Addressing cancer patient caregivers’ quality of life and stress is being recognized as equally important as more cancer patients receive treatment as outpatient and at home placing additional stressors on their home support system. Methods: We evaluated the role of massage therapy on the outcomes of cancer patient caregivers. Patient caregivers were evaluated prior to and after receiving massage therapy with the help of a distress screening tool. We looked at the type of massage they received. Patient caregivers were asked about their pain level, emotional comfort, physical comfort, fatigue level, and given the opportunity to express other comments before and after receiving the massage. Results: Between 08/01/2016 and 05/31/2017, 294 participants received massage therapy at the cancer center. Of these, 265 were patients and 29 were patient caregivers. We evaluated the outcome on patient caregivers. Massages were usually 60 minutes long and consisted of either a Swedish or Deep Tissue massage. Upon review, patient caregivers pain score dropped on average of 2 points. Patient caregivers also noted improvement in their emotional comfort, physical comfort and fatigue level. Most of the caregivers had positive comments regarding the intervention. Conclusions: We recognize that supporting cancer patient caregivers benefits the patients and the healthcare team. We were successfully able to document that by offering massage therapy to patient caregivers improve their pain score, emotional comfort, physical comfort and fatigue level. Successfully implementing this service at the cancer center was welcomed by patients, caregivers and providers and led to positive outcomes. Hopefully, further studies are focused on patient caregivers’ outcomes and their impact.
Open notes: A qualitative study of oncology patients’ experiences reading their cancer care notes.
Authors: Kayastha Neha , Pollak Kathryn I. , LeBlanc Thomas William 
Published: November 2017

33 Background: Electronic medical record systems and patient portals increasingly allow patients direct access to their clinicians’ notes.While most believe that open notes benefit patients, some suggest negative consequences. Little is known about cancer patients’ experiences reading their own medical records outside of the primary care setting. We aimed to describe the experiences of patients with advanced cancer who read their own cancer care notes. Methods: We recruited 20 adult patients with metastatic or incurable cancer who were receiving active cancer treatment to participate in semi-structured qualitative interviews. The interview included four segments: assessing patients' overall experience reading notes, discussing how notes affected their cancer care experiences, having them read a real note with the interviewer, and making suggestions for improving notes. We used a constant comparison approach to analyze the qualitative data. Results: Four main themes emerged; patients reported that notes: (a) increased comprehension, (b) ameliorated uncertainty, relieved anxiety, and facilitated control, (c) increased trust, and (d) for a subset, increased anxiety. Patients described increased comprehension, as notes refreshed their memory and clarified their understanding of visits. Notes addressed uncertainty and relieved anxiety, in part because enhanced comprehension mitigated the unfamiliarity of cancer. They facilitated control, empowering patients to ask more questions to clinicians. The transparency of notes also increased the trust patients have in their clinicians. For a subset of patients, however, notes were emotionally difficult to read and raised concerns. Patients consistently identified medical jargon and repetition in notes as areas for improvement. Conclusions: Our findings suggest that most patients felt that reading notes improved their care experiences. A small subset experienced increased distress from “open notes.” As reading notes becomes a routine part of the patient experience, it is important for physicians to elicit and address concerns that arise from the notes, further engaging patients in their care.
Managing conflict during home hospice nursing visits: Communication between nurses, cancer patients, and spouse caregivers.
Authors: Reblin Maija , Hudson Janella , Clayton Margaret F. , Ellington Lee 
Published: November 2017

39 Background: Many hospice cancer patients and their spouse caregivers experience conflict as roles change and patients decline. Nurses can be asked to mediate conflicts during home visits. Our objective is to describe patient-caregiver conflict and nurse responses in home hospice communication. Methods: A secondary, qualitative analysis was conducted on transcripts of nurse visits to home hospice cancer patients and their spouse caregivers. Transcripts were selected based on high caregiver and patient emotion, identified by interaction analysis coding in primary analysis. Using an iterative process of constant comparison, coders inductively categorized nurse and dyad communication behavior during conflict into overarching themes. Results: 19 visits were identified for analysis. Nurses (from 7 hospice agencies) were all female and averaged 13 years nursing experience (SD = 11). Patient-caregiver dyads were all white, heterosexual, married an average 36 years (SD = 20). 84% of patients were male and average age was 72 years (SD = 9). Caregiver average age was 68 years (SD = 11). Patient-caregiver conflict fell under two major content themes 1) negotiating transitions in patient level of independence and 2) navigating patient/caregiver emotions (e.g. frustration, sadness). When not explicitly asked for input during conflict, nurses occasionally did not engage. Nurse response to transition conflict included problem-solving, mediating, or facilitating dyadic discussion about conflicts/concerns raised with her independently. Nurse response to emotional conflict included validation and reassurance. Conclusions: Little research has been conducted on couples’ conflict resolution in cancer home hospice. However, unresolved conflict can impact the quality of care and has been linked to poor bereavement adjustment. Nurses are sometimes asked to take on the role of mediator, often with little training. Our findings provide insight into home hospice patient and caregiver conflict communication with hospice nurses and could be used during nursing education. Further research could address specific patient and caregiver outcomes associated with nurse communication strategies.
A rules-based algorithm to identify patients who would benefit from re-addressing advance care planning.
Authors: Bestvina Christine M. , Daly Robert Michael , Wroblewski Kristen , Huber Michael , Malec Monica , Chow Selina Lai-ming , Hantel Andrew , Beach Brittany , Polite Blase N. 
Published: November 2017

4 Background: Advance care planning (ACP) should be initiated early and readdressed often for cancer patients. We hypothesize that a rules-based algorithm can predict decreased overall survival, and can be used to target patients who would benefit from readdressing ACP. Methods: We performed a retrospective analysis of 219 patients receiving palliative chemotherapy with leukemia, cholangiocarcinoma, esophageal, gastric, pancreatic, lung or urothelial cancer at the University of Chicago Medicine. Patients were included if they had an index outpatient oncology visit from April 1, 2015 through June 30, 2015. We examined a three-month window from the index visit for a “high-risk event,” defined as: 1. change in chemotherapy 2. emergency department visit 3. hospitalization. Patients were followed from index visit until date of death or last clinical encounter as of January 31, 2017. Each “high-risk event” was treated as a time-varying covariate in a Cox proportional hazards regression model to calculate a hazard ratio of death compared to those without an event. Results: Sixty-seven percent of patients (146/219) experienced at least one high-risk event. A change in chemotherapy regimen, an ED visit, and a hospitalization occurred in 54% (118/219), 10% (22/219) and 26% (57/219) of patients respectively. The hazard ratio of death for patients with at least one high-risk event when compared to those without was 1.72 (95% CI: 1.19-2.46, p=0.003), when adjusted for age, gender, race, marital status, disease type, ECOG, and Charlson score. Inpatient admission independently reached significant for hazard of death. (HR 2.74: 95% CI: 1.84-4.09, p<0.001). Conclusions: The rules-based algorithm identified patients with a greater risk of death. Implementation of this algorithm in the electronic medical record can identify patients with increased urgency to readdress goals of care. [Table: see text]