bluuebunny/crossref_metadata_2025_split huggingface dataset:
Is laser biostimulation safe even when performed in neoplastic fields?
Authors: Ottaviani Giulia , Zacchigna Serena , Gobbo Margherita , Rupel Katia , Guglielmi Alessandra , Bussani Rossana , Di Lenarda Roberto , Biasotto Matteo 
Published: February 2017

3 Background: Oral mucositis and skin dermatitis induced by oncological therapies can impair patients’ functional capacity and quality of life. Laser therapy has been proposed as an effective treatment for both conditions, although with an unclear mechanism. Laser irradiation seems to enhance mitotic activity of epithelial cells, fibroblasts and collagen fibres, but are we sure that it does not stimulate neoplastic cells as well? Two different mice models have been ad hoc created to investigate whether laser therapy can be safely performed even on neoplastic areas. Methods: First model: 4-NQO chemical carcinogen was administered to 50 mice for 16 weeks. During the 17th week, 25 mice were subdued to 4 daily laser therapy sessions (970nm, 2.5W/cm2, duty cycle 50%, 2Hz, 180J/cm2), while 25 mice were used as controls. Afterwards, animals were sacrificed to perform histological analysis. Second model: Melanoma cells were implanted in 48 mice at the dorsal subcutaneous level. A tumour mass developed at the site of injection and mice were homogeneously divided into 4 groups according to tumour size: 3 groups were subject to different laser protocols (660nm, 100mW/cm2, CW, 3J/cm2; 800nm, 1W/cm2, CW, 20J/cm2 and 970nm, 60mW/cm2, CW, 6J/cm2) for 4 consecutive days, while the fourth group was used as control. All animals were euthanized to measure tumour volume and weight, and to quantify tumour invasiveness through immunohistochemistry (CD68 and Melan-A). Results: First model: the number/extension of dysplastic/neoplastic areas did not increased after laser irradiation (p<0.05). Unexpectedly, while carcinomas are normally surrounded by dysplastic tissue displaying different degrees of cells alterations, laser treated carcinomas appeared as insulated lesions surrounded by healthy epithelium. Second model: tumour growth and weight and neoplastic cells infiltration were lower in all laser groups compared to the controls (p<0.05). Conclusions: The above-presented results may also prove that laser therapy can be safely performed to treat oral mucositis and skin dermatitis even in patients with active oncological disease. A key-role of the immune system may explain the peculiar behaviour of carcinomas and melanomas in response to laser irradiation.
Oncologists’ discussions of treatment goals and prognosis during clinic visits with African Americans with advanced cancer.
Authors: Eggly Susan , Hamel Lauren M. , Chou Wen-ying Sylvia , Thai Chan L. , Debono David Joseph , Chapman Robert , Albrecht Terrance Lynn , Penner Louis 
Published: February 2017

34 Background: The National Academy of Medicine recommends that cancer patients be informed of their prognosis to enable informed treatment decisions, but research shows few patients receive this information. This problem is greater for minorities, who experience poorer quality clinical communication and end-of-life care relative to white patients. This study describes patient-oncologist discussions about treatment goals/prognosis during clinic visits with African American patients. Methods: Data were from a larger study of communication between African Americans and medical oncologists at two cancer hospitals in Detroit, MI. The present study included video recordings/transcripts of clinic visits with patients with Stage III (n=20) or IV (n=6) cancer and their oncologists (n=9). Two investigators read the transcripts independently to determine whether treatment goals and/or prognosis were mentioned; disagreement was resolved through discussion. Discourse analysis was conducted to describe interactional strategies oncologists used to discuss or avoid discussing these topics. Results: Treatment goals were discussed during most visits (n=24; 92.3%); prognosis was discussed less frequently (n=19; 73.1%). Oncologists often used vague language to describe prognosis (e.g. prognosis is a bit worse in your case). Only one visit included a clear survival estimate. Oncologists used clear language when the goal was cure, but when describing other goals, they often used technical terms (e.g., reduce the risk of recurrence); imprecise terms (e.g., keep the cancer in check); and emphasized uncertainty (e.g., these lesions are suspicious). Oncologists missed opportunities to further explain or elicit patient questions or preferences by directing the discussion to the urgency and details of treatment. Conclusions: Oncologists used ambiguous language to discuss treatment goals/prognosis and missed opportunities to discuss patient perspectives or other options, including palliative care. Interventions are needed to improve communication about these important topics, especially among minority patients with advanced cancer.
Exploring the preferences for place of death among cancer patients and their family caregivers.
Authors: Vidal Marieberta 
Published: February 2017

40 Background: Understanding the preferred place of death (POD) for advanced cancer patients (Pts) is very important when they are approaching the end of life. Meeting the preferences of Pts is considered an important palliative care (PC) outcome. Prior studies reported that more than 80% of Pts with terminally ill cancer prefer to die at home. In many countries such as the UK, Italy, Greece, South Korea and Japan home deaths have been falling, but in some states of the US and Canada there are indications of a reversal of trends. Dying at home may be more difficult for Pts in severe physical and psychosocial distress, or when there are social or financial difficulties. The purpose of this study was to determine POD preference among PC Pts in the outpatient center (OC) and the palliative care unit (PCU). Methods: A sectional anonymous questionnaire was administered to advanced cancer Pts and caregivers (PCU patients and OC) between August 2012 and September 2014. PCU Pts responded when there was no delirium and the primary caregiver responded when the patient was unable to respond. In the case of outpatients dyads (patient and caregiver) were assessed. Results: Overall 141/216 (65%) preferred home death. PCU patients preferred home death less than outpatients. Patient and caregiver agreement regarding preferred place of death was 86% (p <0.001). The preferred POD was the same as one month ago for 82/99 (83%) PCU Pts and 111/116 (96%) outpatients, with significant difference between groups (p=0.002). Conclusions: Although home is the preferred POD in advanced cancer Pts, a substantial minority prefer hospital death or no difference. Patients admitted to the PCU have a higher preference for hospital death in comparison to the outpatients, likely reflecting more severe distress because they already tried home care. Pts and caregivers agree on POD in most cases. Personalized assessment of POD preference for both patient and caregiver is needed. [Table: see text]
Incorporating patient preferences and priorities into end-of-life care.
Authors: Rackow Eric , Ofori Afua , Rodkey Wendy , Beveridge Roy A. 
Published: February 2017

41 Background: Patients with advanced illness often face painful conversations and difficult decisions. A program was deployed to help patients identify, communicate, and incorporate their personal preferences and priorities into decisions about their care. The program was assessed by measuring movement along the readiness for change continuum. Methods: Patients residing in the home and participating in a chronic care program were referred by their case managers based on clinical conditions and whether the patient appeared to be in their last 12 months of life. Counseling sessions with patients or family caregiver/s were designed to move participants toward the following actions: be fully informed about their medical situation, describe their detailed quality of life priorities, articulate a self-defined medical decision making process, effectively communicate to their family and physicians, and implement and repeat the aforementioned steps. After 5 months (Sept-2014 to Feb-2015), movement along the readiness for change continuum (pre-contemplation, contemplation, preparation, action, maintenance, and advocacy) was reported. Results: Of the 427 patients referred, 33 could not be reached, 116 were ineligible, 50 declined or did not engage. Of the 228 participants, 191 (84%) moved at least one step in readiness for change continuum over the 5-month period. In Nov-2014, 13% of participants were in action, maintenance, or advocacy, which increased to 19% by Feb-2015. The largest observed movement to action, maintenance, or advocacy was in defining quality of life priorities: 2% Nov-2014 to 21% Feb-2015. The least movement to action, maintenance, or advocacy was observed in articulating a self-defined medical decision making process: 3% Nov-2014 to 16% Feb-2015. Case managers reported discomfort in referring members based on their assessment of length of life. Early surveys show high levels of satisfaction. Conclusions: A very high percentage of patients progressed in incorporating their preferences and priorities into end of life care as measured by the readiness to change continuum. This program is currently expanding and the referral process is changing from case manager to algorithm based identification referrals.
The role of the radiation oncologist in goals-of-care discussions.
Authors: Das Lauren C. , Son Christina H. , Daily Ellen Wasgatt , Levine Stacie K. , Hahn Olwen Mary , Liauw Stanley L. , Golden Daniel William 
Published: February 2017

42 Background: Effective goals-of-care discussions (GOCD) are essential when counseling patients with incurable malignancies. Because radiation and medical oncologists (RO; MO) often collaborate, their respective roles in GOCD can be unclear. This study aims to explore how often MO and RO initiate GOCD, barriers to GOCD, and MO opinions of RO conducting GOCD. Methods: RO and MO at NCI-designated comprehensive cancer centers were invited to participate in an anonymous electronic survey. The survey collected demographics and opinions regarding GOCD, training in conducting GOCD, and 3 case scenarios. The participants were provided with the GOCD definition: “A goals-of care discussion defines a patient's expected prognosis, elicits his or her values and preferences, and considers these preferences in formulating a recommendation for treatment and/or supportive care.” Response formats were Yes/No, Likert, or free response. Statistical analysis was performed with chi-squared and Wilcoxon rank-sum tests. Likert scores are reported as median[interquartile range]. Results: 554 RO and 1604 MO were successfully sent survey invitations. 76 (13.7%) RO and 153 (9.5%) MO responded with complete surveys. There was no difference in the gender distribution of survey respondents for RO and MO (67% vs 59% male, p = 0.26). Practice setting was academic medical center for 93% of respondents. 91% of respondents reported seeing ≤ 10 new cancer patients a week. MO were more likely to see metastatic or incurable patients. 63% of RO and 66% of MO reported having GOCD with > 50% of their patients (p = .94). MO were more comfortable conducting GOC discussions compared with RO (5[4-5] vs 4[3-5], p < .01). When asked how important it was for RO to conduct GOCD, RO ratings were higher than MO (5[4-5] vs 4[3-5], p = .02). 18% of RO and 42% of MO received formal training conducting GOCD (p < .01). The most common factors for initiating a GOCD were declining performance status (74%) and poor estimated life expectancy (69%). Conclusions: Although MO and RO conduct GOCD in similar frequency, MO report being more comfortable conducting GOCD and are more likely to have formal training. Compared to MO, RO rate the importance of RO conducting GOCD higher.
Impact of a multidisciplinary home palliative care unit in the place of death of patients diagnosed with cancer.
Authors: Lopez De San Vicente Borja , Arango Juan Fernando , Batiz Jacinto , Gomez Julio , Arrazubi Virginia , San Sebastian Kepa , Aguilo Matxalen , Perez-Hoyos Nany , Oliver Miriam , Sala Gonzalez Maria Angeles , Ruda Pilar , Galve Calvo Elena , Gandiaga Aiala , Novas Patricia , Abad Teresa , Sande Laura , Zumarraga Ane , Lopez Santillan Maria , Martínez del Prado Purificación 
Published: February 2017

45 Background: Home death rate is increasingly being used as a quantifiable indicator of the effectiveness of palliative care services. Intensifying home care and training of the end-of-life care practitioners, seems to be the way to improve the correlation between patient preferences and actual place of death. The objective of this study is to measure the impact of a multidisciplinary home palliative care unit (HPCU) (including medical, nursery, and psycological care, and social worker counselling) on the place of death of patients treated in a single oncology service. Methods: A retrospective case-control study was performed. HPCU patients consecutively admitted from January 2014 to June 2015 (cases) were matched with contemporary patients from the same center who could be followed by independent support services (Home Hospitalization, Psicooncologists and General Practitioners) (controls) by diagnosis, sex, age group ( < 60 years, 61-75y and > 75y) and oncologist physician. Place of death was registered. Odds ratio (ORR) and relative risk was analysed with SPSS for Windows ver.22.00. Results: Seventy four patients (p) admitted in a HPCU and their controls were included; 54% men; Average of age in cases 69.7years (y) (SD 10.8) and controls 68.5 y (SD 10.41), diagnosed of lung cancer 20p (27%), breast cancer 6p (8%), gastrointestinal noncolorectal cancer 16p (22%), colorectal cancer 10p (13.5%), head and neck cancer 5p (6.8%), genitourinary cancer 12p (16%), metastatic melanoma 2p, advanced sarcoma 2p and unknown primary cancer 1p. Place of death: home (cases 43p [59%], controls 8p [10%]); emergency service (1p [1.4%] vs 3p [4.1%]); in acute hospital in-patient-care (AH) (11p [15.1%] vs 29 p [39.2%]) and at a hospitalized palliative care unit (18p [24.7%], vs 34p [45.9%]); 1p of case group was lost during follow-up. The ORR for dying at home for HPCU patients was 11.82 (IC 95% 4.95-28.02) and a reduction in risk of die in an AH was seen (0.38, IC 95% 0.21-0.67). Conclusions: Death at home seems to be more feasible if cancer diagnosed patients have a proper follow-up by a multidisciplinary home palliative care unit, and it also reduce the possibility of dying in an acute hospital in-patient-care.
The influence of caregiver burden on bereavement outcomes of spousal and adult-child family caregivers of patients who have died of cancer.
Authors: McLean Sarah , Gomes Barbara , Calanzani Natalia , Bristowe Katherine , Koffman Jonathan , Higginson Irene J. 
Published: February 2017

49 Background: Family caregivers (FCs) provide unpaid care to patients, outside of a formal framework. A demographic imperative currently exists to allow patients to be cared for in their own homes. FCs are a vital part of this support. However, their needs, and the burden of caregiving, are often under-recognised. Challenges facing FCs, in particular adult-child FCs, include a need to combine paid employment and other family commitments with caregiving. Negative consequences associated with caregiving include a higher risk of complicated grief in bereavement. Aims: To describe and compare the bereavement outcomes of spousal and adult-child FCs of patients who died of cancer, and to evaluate the factors of care associated with adverse bereavement outcomes for each FC group. Methods: Secondary data analysis was performed of data regarding bereavement outcomes, as measured by the Texas Revised Inventory of Grief (TRIG) scores of participants in the QUALYCARE study – a mortality follow-back study of FCs. Results: 484 caregiver-patient dyads were included: 246 adult-child FCs and 238 spousal FCs. Spousal FCs were older (68.4 vs. 50.7 years, p < 0.001). Caregiving intensity was similar in both groups of FCs, but adult-child FCs were more likely to continue working outside the home while caregiving (χ2, p < 0.001). Patients with adult-child FCs were more likely to die in a nursing home than those with a spousal FC (p < 0.001). Grief intensity was highest in spousal FCs whose relative had died in hospital or a nursing home, and lowest in adult-child FCs whose relative had died in a nursing home (n = 31, p < 0.001). Caregiver burden predicted 11.6% of variance in grief intensity for adult-child FCs vs. 0.5% for spousal FCs. Conclusions: Caregiving burden has particular implications for adult- child FCs as compared to spousal FCs, in terms of bereavement outcomes. Role strain describes overlapping responsibilities with simultaneous family roles. The risk of complicated grief may be modifiable through ensuring the provision of practical supports, as well as psychological support for the caregiver, and the excellent management of both physical and psychological symptoms experienced by the patient.
The use of opioids in the last month of life in a tertiary cancer center in Jordan.
Authors: Shamieh Omar M. , Salmany Sewar S , Khamash Odai , Dawood Stella , Alkhreisat Mustafa , Ibrahim Mohamamd , Al-Rimawi Dalia , Hui David 
Published: February 2017

54 Background: The low rates of utilization of opioids is a major barrier to optimal pain control in cancer patients in developing countries. The presence of a palliative care service may improve opioid utilization. In our study we assessed opioid utilization in the last month of life for patients admitted to our tertiary care cancer center in Jordan, and compared the use of opioids with and without palliative care involvement. Methods: We conducted a retrospective chart review to examine opioid use for all adult patients who died at King Hussein Cancer Center between January 1st, 2012 until December 31st, 2012. Patient demographics, cancer diagnosis, type of opioid and total daily dose of opioids in morphine oral equivalent (OME) were collected in the last 30 days of life while admitted to the hospital. Results: Among the 297 patients included, the median age was 58 years (range, 19- 95), 134 (45%) were males, and 186 (62.6%) died under the palliative care service. The median admission length was 7 days. The average daily doses of opioids were 187mg, 214mg, 222mg (OME) in the last 24 hours, 48 hours, and 30 days of life, respectively, In the last 24 and 48 hours before death, 140 (47%) and 228 (77%) patients were on opioids, respectively. Younger age was associated with higher doses of opioids (P= 0.0001). We found no significant differences in patient characteristics between palliative and non-palliative care patients; however, patients under palliative care received significantly higher doses of opioids compared to non-palliative care patients in the last 30 days of life, the average daily dose of opioids (OME) was 249.4mg vs. 11.2mg (P< 0.001). There was no survival difference between palliative and non-palliative patients (P= 0.2244), or between patients who were on opioids or patients who were not (p= 0.57). Conclusions: A large minority of patients did not receive opioids at the end-of-life. Palliative care service was associated with higher utilization of opioids. Palliative care service may assist in pain management at the end-of-life.
Difference in strong opioid prescription among different cancer and care providers in advanced cancer patients in Taiwan: Analysis using national health insurance database.
Authors: Hsieh Ruey Kuen , Lin Yu-Lin , Tang Chao-Hsiun 
Published: February 2017

55 Background: Pain assessment and management had been adopted as an important criteria in hospital accreditation in Taiwan. National health insurance database may help to determine factors influencing patterns of strong opioid use in advanced cancer patients in their final 12 months of life. Methods: Cancer patients who died from cancer during 2008-2011 were included in the analysis. Data in prescription of strong opioids during their last 12 months of life were collected and analyzed using National Health Insurance Research Database (NHIRD). Patient’s characteristics, such as cancer types, birthdate and gender, as well as information on the provider’s characteristics, such as specialty, gender and age of the physician, the ownership and level of accreditation of the hospital, and the level of urbanization of the hospital where it is located, were also retrieved and included as the controlled variables in the analysis. Results: Of the 162,679 cancer deaths, 57,578 were prescribed strong opioids in their last year of life (35.4 percent). Strong opioid prescription steadily decreased with the corresponding increase in patient age. Besides there are difference in different cancer types. Association with prescription prevalence has also been noted among physician characteristics such as subspecialty, gender and age, as well among hospital characteristics, such as public vs private and accreditation level. Conclusions: There are significant difference in strong opioids prescription among different care providers for advanced cancer patients. Information from this study can guide further efforts in improving supportive care and education for advanced cancer care providers.
Radiotherapy (RT) for brain metastases (BM) near the end of life (EOL): Palliation or poor-quality care?
Authors: Ryoo Joan Joonsun , Batech Michael , Zheng Chengyi , Kim Raymond W , Gould Michael K , Kagan A. Robert , Lien Winston Wei 
Published: February 2017

58 Background: Patterns of care and EOL RT among BM patients (pts) are not well-described. Methods: Tumor registry of an integrated health care system identified 5,133 pts diagnosed with non-small-cell lung cancer (NSCLC) in 2007-2011. BM were determined by imaging. Clinical variables obtained by chart abstraction were tested as predictors of death within 14 and 30 days (d) of RT. Results: On NSCLC presentation, 10% had BM; 7% developed BM thereafter. Of 900 BM pts, 15% were not referred for brain RT due to pt preference or clinical judgments; median time to death was 21 d (range 0-578). Median survival for 5% not recommended RT was 48 d (range 13-764). Though survival was shorter when prescribed 5 vs 10 fractions (78 vs 179 d, p<0.01), suggesting providers’ sense of prognosis, 15.6% of pts died ≤14 d and 23.3% ≤30 d of RT. Inpt consultation and planned fractions were higher at external RT facilities, and RT more likely not to be completed (p<0.01). Independent predictors of EOL RT were older age, poor performance status, increasing metastatic sites, and RT consultation during hospital admission. Conclusions: BM incidence in this NSCLC cohort was 17%, with 85% referred for brain RT. A concerning number of pts received RT near the EOL. While RT recommendation, timing, and fractionation – especially on inpt evaluation – should be better tailored to life expectancy, benchmarks for quality measurement are needed. [Table: see text]