bluuebunny/crossref_metadata_2025_split huggingface dataset:
Enhancing palliative care patient access to outpatient and outreach counseling services.
Authors: Guzman Diana , Bruera Eduardo , Williams Janet L. , Najera John M , Raznahan Monica , Ann-Yi Sujin , Carmack Cindy L. 
Published: November 2017

184 Background: MD Anderson’s interdisciplinary out-patient clinic, palliative care team includes mental health professionals who provide psychological care, including 3 full time Master’s level counselors. Counseling sessions are offered during the patient’s clinic appointments. To increase opportunity and access for additional counseling, patients are offered follow-up counseling through an outreach program which includes videoconferencing or telephone sessions. The data presented represents almost 2 years of our Master’s level clinicians’ practices. Methods: Retrospective chart review of 2041 consecutive patients (3606 total contacts) seen for psychology counseling services in the Supportive Care Center between 6/2015 and 3/2017. Results: Counselors saw 2041 consecutive patients (52% of the patients seen at the out-patient Supportive Care Center). Most patients only had 1 session in clinic (63%); almost 1/3 received 2-5 sessions (33.9%). Median time for the follow-up visit was 30.5 days. Approximately 25% (N = 511) were offered outreach services; 79% (N = 405) of those offered received these services. Median number of outreach sessions received was 1 (57%); 2-5 (38%); 6-9 (4%) and 10+ (1%). Sessions lasted 10-15 minutes (58%); 20-35 minutes (31%); and 40+ minutes (11%). Patient preferred mode of outreach included telephone (93%), Facetime (5.0%), and videoconferencing (2%). In total, 798 outreach sessions were provided representing 18% of total counseling sessions offered. Conclusions: The out-patient palliative care service is able to offer psychological assessment and counseling to more than half of the patients they serviced due to the addition of 3 Master’s level counselors embedded in the clinic. Follow-up counseling for these patients can be challenged for those residing in rural areas, with limited resources and/or transportation problems, and with physical limitations that make travel difficult. Our outreach program has successfully enhanced access to services to patients who otherwise may have had limited to no follow-up psychosocial care.
Illicit substance use and opioid misuse in adolescent and young adult (AYA) patients with cancer.
Authors: Oberoi-Jassal Ritika , Chang Young Doo , Smith Joshua , Rajasekhara Sahana , Desai Vijay , Fenech Alyssa L , Reed Damon R. , Portman Diane , Donovan Kristine A. 
Published: November 2017

205 Background: Rates of illicit substance use and misuse of opioid medications are high in the adolescent and young adult (AYA) general population. Despite this, screening for substance use and opioid misuse is not standard in the care of AYA oncology supportive/palliative care. To inform our clinical practice, we sought to determine the prevalence of illicit substance use and potential opioid misuse in AYA cancer patients relative to adult patients and to examine correlates of use and misuse. Methods: We conducted retrospective chart review of patients newly referred to an outpatient palliative care clinic between 2014 and 2016. Results: Consecutive patients (N = 963) underwent urine drug testing as part of their initial visit; 16% of patients were between 18 and 39 years of age. Rate of illicit drug use was 31% for AYAs and 19% for adults. AYAs were nearly 2 times more likely to have positive results for marijuana (OR = 1.79; 95% CI = 1.19 – 2.69) and nearly 3 times more likely to test positive for amphetamines (OR = 2.94; 95% CI = 1.15 – 7.49). AYAs were no more likely than adults to test positive for cocaine, barbiturates or heroin. In univariate analyses, only male sex and being single, and no clinical characteristics or symptom scores, were significantly associated with illicit substance use (ps < .05). AYAs were no more likely than adults to test positive for the presence of opioids, not currently prescribed (OR = 1.07; 95% CI = 0.70 – 1.65). No symptoms scores or demographic and clinical characteristics were significantly associated with misuse. Conclusions: AYA patients demonstrated a high rate of illicit substance use and similar rate of potential opioid misuse relative to adult patients. Findings suggest AYAs may benefit from consistent screening, support and treatment for substance use and potential opioid misuse during anticancer and cancer-related therapies.
Factors associated with participating in formal support services among family caregivers of older adults with poor-prognosis cancers.
Authors: Dionne-Odom J Nicholas , Applebaum Allison , Ornstein Katherine , Azuero Andres , Warren Paula , Taylor Richard A. , Rocque Gabrielle Betty , Kvale Elizabeth Ann , Demark-Wahnefried Wendy , Pisu Maria , Partridge Edward E. , Martin Michelle Y , Bakitas Marie 
Published: November 2017

21 Background: Family caregivers of persons with cancer are at high risk for distress and may benefit from formal support services. The purpose of this study was to describe cancer family caregiver’s use of and desire for formal support services. Methods: Cross-sectional mail survey conducted in communities of eight cancer centers in Tennessee, Alabama, and Florida. Family caregivers of Medicare beneficiaries with pancreatic, lung, brain, ovarian, head and neck, hematologic, and stage IV cancers reported support service use and completed validated measures of depression, anxiety, burden, preparedness, and health. Results: Caregivers(n = 294) were on average age 65.5 years and mostly female (72.8%), white (91.2%), and care recipients’ spouse/partner (60.2%). Patients averaged 75.3 years and were mostly male (54.4%). Formal support services were used by 32.0% (n = 94) of all caregivers; 4.4% used therapy or counseling, 19.7% received education and training; and 11.2% received assistance from local, state, or national organizations. Twenty-eight percent of all caregivers were “mostly or “extremely” interested in receiving support services; of those, 44% had high depressive symptoms, 52.3% had high anxiety symptoms, and 36.4% in the lowest quartile of preparedness. In multivariate analyses, participation in services was significantly associated with lower objective burden, higher preparedness, not working, and not being the patient’s spouse. Being “mostly” or “extremely” interested in support services was significantly associated with being a minority, shorter durations of caregiving, and with higher stress burden. Conclusions: While distressed and underprepared family caregivers reported strong interest in formal support services, only a small proportion accessed these services. Strategies to increase service use may include targeting those caregivers who are still early in their caregiving experience and who report high stress burden.
A systematic review and meta-analysis of randomized controlled trials to evaluate the risk of fatigue and pain among patients with metastatic solid tumors treated with cabozantinib.
Authors: Han Myat M. , Thein Kyaw Zin , Zaw Myo , D'Cunha Luke , Perisetti Abhilash , Hardwicke Fred L. , Tijani Lukman 
Published: November 2017

214 Background: Fatigue and pain notably contributed to the quality of life of cancer patients undergoing chemotherapy. Cabozantinib inhibits the activity of VEGFR, AXL, MET and other receptor tyrosine kinases which are essential in tumor development and progression. Yet the impact of this agent on fatigue and pain is a considerable safety concern. We undertook a systematic review and meta-analysis of randomized controlled trials (RCT) to determine these risks. Methods: MEDLINE, EMBASE databases and meeting abstracts from inception to March 2017 were queried. Phase 3 RCTs that mention fatigue, asthenia, back pain, pain in arms and legs, arthralgia, muscle spasm and bone and musculoskeletal pain as adverse effects were incorporated in the analysis. Mantel-Haenszel method was used to calculate the estimated pooled risk ratio with 95% confidence interval (CI). Results: Three phase 3 RCTs with a total of 1999 patients were eligible for analysis. Studies compared cabozantinib (C) vs everolimus, C vs placebo, C vs prednisone, were included in the analysis. The relative risks (RR) of all-grade adverse effects were as follows: fatigue, 1.34 (95% CI: 1.19- 1.50, p < 0.0001); asthenia, 1.48 (95% CI: 1.06- 2.06, p = 0.02); back pain, 1.08 (95% CI: 0.84- 1.38, p = 0.52); pain in arms and legs, 1.44 (95% CI: 1.12- 1.84, p = 0.004); arthralgia, 0.98 (95% CI: 0.70- 1.36, p = 0.91); muscle spasm, 2.59 (95% CI: 1.63- 4.12, p < 0.0001); bone pain, 1.22 (95% CI: 0.35- 4.21, p = 0.74); and musculoskeletal pain, 0.64 (95% CI: 0.42- 0.96, p = 0.03). The RR of high-grade adverse effects were as follows: fatigue, 1.84 (95% CI: 1.36- 2.48, p < 0.0001); asthenia, 2.02 (95% CI: 1.37- 2.99, p < 0.0001); back pain, 1.17 (95% CI: 0.69- 1.98, p = 0.54); pain in arms and legs, 2.93 (95% CI: 1.12- 7.63, p = 0.02); arthralgia, 0.82 (95% CI: 0.39- 1.70, p = 0.59); bone pain, 1.20 (95% CI: 0.28- 5.10, p = 0.79); and musculoskeletal pain, 1.34 (95% CI: 0.38- 4.64, p = 0.64). Conclusions: Cabozantinib increased the risk of all-grade and high-grade fatigue, asthenia and pain in arms and legs as well as all-grade muscle spasm whereas the risk of musculoskeletal pain was lower in the study arm, favoring cabozantinib.
Risk factors and prophylaxis of irinotecan induced cholinergic syndrome in sight of supportive care.
Authors: Fujii Hiroyuki , Hirata Taizo , Mura Takuya , Okada Yuko , Ito Takuo , Ozaki Shinji , Tashiro Hirotaka , Mizunoe Tomoya , Kohno Hiroshi , Nakano Kikuo 
Published: November 2017

216 Background: Irinotecan Induced Cholinergic Syndrome (IICS), manifesting in such events as early diarrhea and diaphoresis, is well-known adverse effect of irinotecan. These symptoms occur within the first 24 hours of irinotecan administration and can be ameliorated with anticholinergic agents. Although IICS is transient and tends to be underestimated, diarrhea and abdominal pain during drug infusion are inflictive and make patients reluctant to undergo anticancer therapy. Methods: First, to identify the risk factors that are associated with IICS, 132 consecutive patients who were treated with a chemotherapeutic regimen that included irinotecan at Kure Medical Center between 2012 and 2017 were retrospectively analyzed from the aspect of sex, age, dose, cancer type, regimen, kidney function, and renal function. Secondly, to determine the response rate of butylscopolamine bromide for IICS, we injected butylscopolamine bromide 20mg into the irinotecan infusion bag and administered both agents through the intravenous line together to patients who experienced IICS. Results: IICS occurred 14 of 132 patients (10.6%); these 14 patients were given butylscopolamine bromide by coinjection for total 119 cycles. Univariate analysis indicated that dose (p = 0.0029), cancer type (p = 0.0023) and regimen (p = 0.0005) was associated with IICS. Patients with symptoms tended to be administered a higher irinotecan dose than those without symptoms (127.9±20.4mg/m2 and 99.6±34.1mg/m2). By logistic regression analysis, a higher dose (dose > 105mg/m2) was identified a significant risk factor for IICS (Odds Ratio = 10.9; 95% Confidence Interval: 2.0 to 96.7; p = 0.0121). 13 patients (105 cycles) of 14 patients (119 cycles) who were administered butylscopolamine bromide, experienced complete or partial improvement of IICS. The response rate was nearly 90%. Conclusions: A higher dose of irinotecan is a significant risk factor for IICS. To avoid creating a disincentive for patients to undergo anticancer therapy, the prevention of IICS is paramount. As prophylaxis of IICS, mixing butylscopolamine bromide into the irinotecan infusion bag was remarkably effective.
Novel approach for cancer-related fatigue: A double-blind randomized clinical trial.
Authors: Sette Claudia Vaz De Melo , de Alcântara Barbara Bonaparte Ribas , Cruz Felipe Melo , Schoueri Jean Henri Maselli , Cubero Daniel de Iracema Gomes , Del Giglio Auro 
Published: November 2017

234 Background: Fatigue is one side effect of cancer and its treatment, and remains as the most prevalent symptom for those who survived. To date, the search for novel approaches regarding Cancer-Related Fatigue persists. As such, Paullinia cupana – a medicinal plant – has shown promising results for the treatment of chemotherapy-induced fatigue. Methods: We conducted a phase II randomized double-blind clinical trial, in which we compared a standardized dry purified Paullinia cupana extract (PC-18) - in doses of 7.5 mg and 12.5 mg given orally twice a day - to placebo for the treatment of fatigue in women with early breast cancer scheduled to receive their first cycle of adjuvant systemic chemotherapy. Only patients that experienced increase in the score of either BFI, HAD or Chalder fatigue scales following the first cycle of chemotherapy were included. For possible associations between qualitative variables, Chi-square test was used. Poisson regression was used to test for the relationship between the drug used and the outcome regarding the difference assessed in scores aforementioned. The significance level was 5%. The program used was Stata 12.0. This study has been approved by our Institutional Review Board (number: 34327214.1.1001.0082) and participants have all signed informed consent forms. Results: PC-18 on 7.5 mg has not been statistically significant with any improvements on assessed scores when compared to placebo (IRR 0.99 [CI] 0.81 – 1.23, p = 0.958 for BFI; IRR 1.04 [CI] 0.56 – 1.95, p = 0,898 for HAD; IRR 0.95 [CI] 0.75 – 1.19, p = 0.645 for Chalder), while greater dosage (12.5mg) has shown the following outcomes regarding the scores (IRR 0.49 [CI] 0.30 – 0.81, p = 0.005 for BFI; IRR 0.89 [CI] 0.45 – 1.76, p = 0,735 for HAD; IRR 0.99 [CI] 0.80 – 1.23, p = 0.914 for Chalder) in the same comparison. Conclusions: Disregarding preliminary data on previous studies, PC-18 has not shown to be better than placebo. Clinical trial information: 34327214.1.1001.0082.
BMI and health-related quality of life (HR-QoL) in patients with metastatic colorectal cancer (mCRC).
Authors: Formica Vincenzo , Nardecchia Antonella , Pellegrino Rachela , Massimiliani Valentina , Donnarumma Luisa , Giuliano Greta , Renzi Nicola , Mariotti Sabrina , Portarena Ilaria , Laudisi Anastasia , Morelli Cristina , Lucchetti Jessica , Perrone Lorena , Riondino Silvia , Roselli Mario 
Published: November 2017

249 Background: Relationship between BMI and HR-QoL has been extensively studied in CRC survivors. Increasing BMI has been recently associated with improved survival in mCRC pts, however data on the relationship between BMI and common HR-QoL measures in mCRC are scarce Methods: The EORTC QLC C30 and the NCCN distress thermometer (DT) and problem list (PL) questionnaires were administered to consecutive mCRC pts candidate for firstline chemotherapy. The effect of BMI on HR-QoL were analyzed using the Kruskal-Wallis and Mann-Whitney tests. The interaction between BMI and other variables of interest (such as inflammatory indexes) for the effect on HR-QoL was also analysed using a logistic regression analysis Results: Of 135 screened pts, 119 completed the questionnaires. A direct association was observed between BMI and GH score, with the score gradually improving from BMI 14 to 21, then plateauing between 21 and 41. A significantly lower GH was observed for BMI < 21 vs > 21 (GH 50 vs 67, p 0.014). DT and BMI were not correlated. BMI was inversely associated with practical problems (mean number of reported problems 0.7 vs 0.4 for BMI < 24 vs > 24, p0.012). The other components inversely associated with BMI were appetite loss, pain and fatigue (which were higher for BMI < 21 , p values 0.033, 0.015 and 0.007, respectively). A direct association with BMI was also observed for social and physical functioning (p values 0.002 and 0.05, respectively). Median BMI in pts with GH score < 25 vs > 25 was 19 vs 25, p 0.05. Percentage of pts with very low BMI (BMI < 21) was 38% vs 2% for pts with GH < 25 vs > 25, respectively, Odds Ratio 32.4, p 0.0007. Among 15 common clinical and biochemical analysed variables, the inflammatory index neutrophil/lymphocyte ratio (NLR) demonstrated a significant interaction with BMI for the effect on GH, with the direct association between BMI and GH only retained in pts with low NLR and a deteriorated GH in pts with high NLR regardless of BMI, test for interaction p 0.013 Conclusions: Low BMI is associated with deteriorated HR-QoL in mCRC pts with low NLR approaching a first-line treatment. Adequate nutritional support and anti-inflammatory approaches would improve HR-QoL in these pts.
Assessment of the impact of the Hospital Anxiety and Depression Scale on the initiation of treatment in newly diagnosed cancer patients in a safety-net hospital.
Authors: Singh Daulath , Singh Annapoorna , Grover Punita , Indaram Mahathi , Malomo Nikki , Cheng An-Lin , Johnson Richard Arden , Madhusudhana Sheshadri 
Published: November 2017

250 Background: Distress is a universal symptom in oncologic patients which negatively impact the quality of life and survival. It interferes with the ability to cope with the diagnosis and is a risk factor for non-adherence with treatment. The Hospital Anxiety and Depression Scale (HADS), is used at our institution for distress screening. The aim of our study is to assess the impact of distress, measured by the HADS score, on initiation of treatment in newly diagnosed cancer patients. Methods: We conducted a retrospective chart review of patients with a new diagnosis of cancer, between March 1st, 2014 and December 31st, 2015; who had been evaluated for distress at their first oncology clinic visit. We included only patients who were treated with chemotherapy or chemoradiation, with curative intent. Poisson regression analysis was conducted to investigate the relationship between HADS to treatment initiation while including age, sex, race, insurance status, cancer type, and stage as covariates in the model. Results: A total of 101 patients met the inclusion criteria. The mean age was 54 years, 63% were female and 37% were male. The majority were Caucasians (53%), followed by African-Americans (36%). 56% of the population had Medicaid, and 26% had Medicare and private insurance. The most common cancers were – breast (30%), gastrointestinal (20%), gynecologic (15%) and lung (11%). 64% received chemotherapy and 36% were treated with chemoradiation. We grouped patients into 3 categories based on the HADS score – category 1 with score ≤7 (28%), category 2 with score 8-10 (17%) and category 3 with score ≥11 (55%). The median time to treatment initiation was 28 days. Multivariate Poisson regression analysis did not show any correlation between the HADS score and treatment initiation. Subscales analyses showed that higher depression scores correlate with a delay in treatment initiation (p-value 0.01), while the anxiety scores had no influence (p-value 0.57). Conclusions: In our study, the initial total HADS score did not affect the treatment initiation. Interestingly, depression had an influence on the initiation of treatment in newly diagnosed cancer patients.
The effect of message content and clinical outcome on patients' perceptions of physician compassion: A randomized controlled trial.
Authors: Tanco Kimberson Cochien , Azhar Ahsan , Rhondali Wadih , Rodriguez-Nunez Alfredo , Liu Diane D , Wu Jimin , Baile Walter F. , Bruera Eduardo 
Published: November 2017

27 Background: In a previous randomized cross-over study, patients perceived a physician delivering a more optimistic message as more compassionate and professional. However, the impact of the clinical outcome of patient on patients’ perception of physician’s level of compassion and professionalism has not been previously studied. Our aim was to determine if the reported clinical outcome modified the patient’s perception of physician compassion, professionalism, impression, and preference for physician. Methods: 128 advanced cancer patients in an outpatient Supportive Care Center were randomized to complete validated questionnaires about patients’ perception of physician’s level of compassion, professionalism, impression and preference of physician for themselves and their family after watching scripted videos depicting a physician delivering a more optimistic (MO) vs. a less optimistic (LO) message followed by a clinical vignette depicting a worse outcome. Results: Median age was 61 years and 55% were female. There was no difference in compassion score after the vignette for both the MO and LO groups respectively [mean difference (SD): 1.7(8.74) p = 0.4684 vs. 0.89(10.24) p = 0.1225] but there were worse overall impression [mean difference (SD): MO -0.79(1.62) p < 0.0001 vs. LO -1.17(1.91) p < 0.0001] and professionalism scores [MO -0.88(2.25) p = 0.0022 vs. LO -0.76(2.22) p = 0.0094]. In the MO group, preference for the physician for themselves [mean difference (SD) -0.29(0.77) p = 0.0049] and their family [mean difference (SD) -0.29(0.71) p = 0.0009] decreased after the vignette. Conclusions: Seeing a worse clinical outcome did not change the patients’ appraisal of an inappropriately optimistic physician. However, it reduced the overall impression of both physicians that conveyed a more or a less optimistic message and it also resulted in less likelihood of choosing the more optimistic physician for themselves and their family. Clinical trial information: NCT02498899.
Family companions’ involvement during pre-surgical consent visits for major cancer surgery and its relationship to visit communication and satisfaction.
Authors: Isenberg Sarina , Aslakson Rebecca , Dionne-Odom J Nicholas , Smith Thomas J. , Smith Katherine Clegg , Singh Sarabdeep , Wolff Jennifer L , Roter Debra 
Published: November 2017

30 Background: While research has explored the role of companions (accompanying family members) in medical visits, studies have not examined companions’ involvement in pre-surgical visits. This study explored how companions’ presence impacts communication and satisfaction during pre-surgical visits to discuss major cancer surgery. Methods: Secondary analysis of 61 pre-surgical visit recordings with 8 surgical oncologists at an academic tertiary care hospital. Recordings were analyzed using the Roter Interaction Analysis System, and surgeons and patients completed a post-visit satisfaction questionnaire. Poisson and logistic regression models were used to assess differences in communication and satisfaction when companions were present (n = 46, 75%) and not present (n = 16, 25%). Models were fit using generalized estimating equations to account for nesting of patients within surgeons. Results: Companion communication was largely emotional and facilitative. In unadjusted analyses, companion presence was associated with a 29% increase in surgeon talk in the visit overall (IRR 1.29, p = 0.006), and a 41% increase in the amount of medical information provided (IRR 1.41, p = 0.001). Companion presence was associated with 45% less patient disclosure related to lifestyle/psychosocial topics (IRR 0.55, p = 0.037). In adjusted analyses, companions’ presence was associated with 23% lower levels of patient-centeredness (IRR 0.77, p 0.004). No difference between visits with and without companions in patient nor surgeon satisfaction. Conclusions: Companions’ presence increased the medical focus of the discussion; surgeons conveyed more medical information, and patients disclosed less psychosocial information. Companions might perceive patients as anxious prior to major surgery, compelling companions to advocate for the patient. Companion’s presence might be beneficial; however, this benefit might not be captured by the patient-centeredness ratio. As there was no difference in satisfaction, patient and surgeon satisfaction may not be predicated on patient-centeredness, but on the conveyance of timely, surgery-related information. Clinical trial information: NCT02489799.