bluuebunny/crossref_metadata_2025_split huggingface dataset:
The impact of tailored nutrition intervention and dietary counseling on body weight in female cancer cachexia patients in India.
Authors: Kapoor Neha , Tewfik Ihab , Naufahu Jane , Tewfik Sundus , Garg Rakesh , Bhatnagar Sushma 
Published: February 2017

67 Background: The prevalence of malnutrition, amongst cancer palliative patients, is 81%. As cancer progresses, patients’ develop malnutrition owing to metabolic changes and ill-effects of treatment. The aim of this study was to improve nutritional status of female cancer patients and their quality of life by counseling and providing nutrient rich natural food (IAtta). Methods: Female cancer patients (n=45) attending palliative care clinic (AIIMS, New Delhi); with symptoms of cachexia were randomly distributed into control (Group one, n=23) and intervention group (Group two, n=22). Both groups were provided with nutritional counseling while the intervention group also received 100grams of IAtta, to be consumed daily for three months. Anthropometric measurements [weight, muscle mass, percentage body fat (%BF) and mid upper arm circumference (MUAC)], dietary intake (two day dietary recall) and quality of life (European Organisation for Research and Treatment of Cancer-Quality of Life C30 Questionnaire) were assessed at baseline and after three months. Data was analysed using paired t-test and Wilcoxon signed-rank test on the variables assessed. P-value < 0.05 was considered statistically significant at 95% confidence interval. Results: Patients in group one had significantly decreased body weight (p= 0.001), muscle mass (p= 0.021), MUAC (p= 0.005) and %BF (p= 0.001) by end of three months. While patients in group two reported significant improvement in fatigue (p= 0.001) and appetite loss score (p= 0.002) under quality of life domains. Conclusions: Nutritional counseling along with IAtta food supplementation helps in stabilising weight and improves quality of life of cancer cachexia patients undergoing palliative care treatment. Clinical trial information: RP- 02/17.06.2013. [Table: see text]
Early palliative care: Recognizing the patient in need of palliative care and proactive palliative care planning with the GP as coordinator—An RCT.
Authors: Engels Yvonne , Groot Marieke de , Thoonsen Bregje , Verhagen Stans , Vissers Kris , Weel Chris van 
Published: February 2017

69 Background: In the Netherlands, many patients that might profit of palliative care don't receive it or don't receive it until the terminal phase. GPs in the Netherlands consider palliative care as an important task, but they don't feel confident to recognize the patients in need of palliative care and to provide it in a structured way. For that reason, we performed an RCT in which GPs in the intervention condition received training in recognozing the palliative patient and in early palliative care provision. Methods: Randomized controlled cluster trial (intention to treat) with GP as cluster. GPs in the intervention group received a 5-hours training in early recognition of the palliative patient, with the help of the RADPAC tool, and in proactive palliative care planning. They were invited to identify the patients in need of palliative care and provide the care as learned in the training. Primary outcome: number of out-of-hours contacts with the out-of-hours service, as measured retrospectively by analysing all patients that died during the intervention period of one year. Secondary outcomes: number of hospitalizations and place of death, also collected retrospectively. Results: Within one month, 159 GPs showed their interest to participate. Per responding GP, a mean number of 7 patients died during the intervention period. About 45% of the patients died at home, in both study groups. We did not find differences in out-of-hours contacts, hospitalizations and place of death between intervention and control group. Conclusions: We did not find differences between intervention and control group. As learning to identify the palliative patients was part of the intervention, we were not able to collect patient-related outcomes in the control group. This might explain why we did not find significant effects of early palliative care, in contrast to findings of Temel et al, and Zimmermann et al. and Bakitas et al. For that reason, we recommend to measure quality of life as primary outcome. Clinical trial information: NTR2815.
Identifying palliative care beds to contribute to the integration of early palliative care (EPC) into the inpatient, private practice oncology setting in Brittany (France).
Authors: Parot-Monpetit Anny , Monpetit Erik 
Published: February 2017

71 Background: In France, since 2002, Identified Palliative Care Beds (LISP) has contributed to the diversification and development of Palliative Care. They are identified in acute unit with significant PC activity and estimated at 5000 in 2011. In our Brittany private hospital, since fall 2008, 8 Beds are dedicated to PC in the solid tumour oncology unit (47 beds) and allowed EPC integrated to oncologic care for inpatients. Our model incorporated a PC physician as a second attending on service alongside the rounding oncologist. Time for discussions with oncologists is optimized and warranted decisions about providing adequate information to the patient and the continuation of treatments, specific or not. We thought to better define the added value of Identified PC Beds. Methods: Because more financial and educational resources are attributed to Identified Beds by health authorities to offer a true interdisciplinary approach, a specific annual evaluation is required. We analysed 7 quantitative components and the number of claimed letters about the unit between 2008 and 2013. Results: The table show an increased PC activity no reduced to terminal care (increase Home Hospice Care, decrease death) and better provider satisfaction with oncology care. Conclusions: The French concept of Identified PC Beds, in our experience, may improve early integrated PC into the inpatients and quality of care. The co management of patients with advanced cancer by oncologists and palliative care physicians is the key. Formal study of our Identified PC Beds model is warranted. [Table: see text]
Building a patient-centered model: Palliative medicine and cancer care.
Authors: Ramchandran Kavitha , Galligan Derek , Tribett Erika L , Valentine Melissa , Selig Meryl , Blayney Douglas W. , Asch Steven M 
Published: February 2017

75 Background: Palliative medicine (PM) improves outcomes for cancer patients. Still, there is limited evidence around components of an efficient, patient-centered model for integrating PM into oncologic care. While PM is committed to aligning with a patient's goals of care, very few programs incorporate their input into design or evaluation. The aim of this project is to combine best practice in PM with perspectives of patients, families and providers to develop an empathic PM service. We hypothesize that collaboration with stakeholders and user experience experts will result in a feasible, impactful and translatable model of care that aligns with patient and family goals. Methods: We are conducting semi-structured interviews with 30 patients, family members and 30 oncologists. Patient interviews assess needs and coping mechanisms. Provider interviews assess perceptions and experiences around PM. We will conduct observations to understand how patients and providers interact and how current protocols are operationalized. Data will be coded and analyzed for major themes. An expert panel of patients, family members, health care providers and design experts will assimilate the data and make recommendations for the prototype care model design. The model will be piloted and evaluated in fall 2014. Outcome metrics include patient satisfaction, symptom management, utilization, mortality, and others identified during development. Data from the pilot will inform intervention improvements in preparation for a large-scale, 12- month pilot in an outpatient PM clinic. Results: Preliminary work includes the development of a novel patient and family interview protocol that integrates cutting-edge research on PM with best practices for conducting empathic interviews. We will present initial results from these interviews at the symposium, as well as our iterative design process. Conclusions: This project integrates data on patient and family experience with known best practices to develop a patient-centered model for palliative cancer care. The development process and potential outcomes hold significant promise for the design of patient and provider-centered care models, especially those related to chronic and serious illnesses.
Impact of mindfulness training on avoidant coping and advance care planning.
Authors: Johns Shelley A. , Beck-Coon Kathleen , Schmidt Karen , Stump Timothy E. , Bernat Jennifer Kim , Torke Alexia M. , Helft Paul R. 
Published: February 2017

86 Background: Timely end-of-life (EOL) discussions and advance care planning (ACP) are crucial to quality cancer care; however, patients, family caregivers (CGs), and oncologists often avoid these tender conversations. When EOL discussions are avoided, patients are more likely to receive non-beneficial treatment near death and CGs are more likely to experience psychiatric disturbance. Mindfulness meditation facilitates emotional regulation and may enhance adaptive coping necessary for EOL discussions and ACP. Methods: Mindfully Optimizing Delivery of End-of-Life (MODEL) Care is a within-group pilot study developed to train patients with advanced-stage solid malignancies and their CGs (n=13 dyads) in present-moment awareness and non-reactive coping through a variety of mindfulness practices. Eligible patients met a threshold for avoidant coping and had not completed a Physician Orders for Scope of Treatment (POST) form documenting care preferences. Cognitive avoidance and quality of life (QoL) for patients and CGs were assessed from baseline (T1) to post-intervention (T2) and 1-month follow-up (T3) with standardized response mean (SRM) effect sizes. ACP from T1 to T3 was assessed descriptively. Results: Moderate decreases in cancer-related avoidance were found for patients (SRM=-0.47) and CGs (SRM=-0.59) T1 to T2, while T1 to T3 effects were small for patients (SRM=-0.31) and large for CGs (SRM=-1.12). At T1, no patient had completed a POST form; by T3, 50% reported completing one and 40% were preparing to do so soon. At T1, 23% of patients reported having had a ‘goals of care’ discussion with their oncologist, with 82% doing so by T3. At T1, 46% of patients reported having discussed ‘goals of care’ with their CGs, with 100% doing so by T3. Large improvements in QoL were found at both time points for patients and CGs (SRMs ranging from 0.85 to 1.21). Conclusions: Mindfulness was associated with mostly moderate reductions in avoidant coping and large improvements in QoL for patients and caregivers, with notable ACP progress for patients.
Prevalence and predictors of burnout among specialty palliative care clinicians in the United States: Results of a national survey.
Authors: Kamal Arif , Bull Janet , Wolf Steven , Samsa Greg , Ast Katherine , Swetz Keith Mark , Shanafelt Tait D. , Abernethy Amy Pickar 
Published: February 2017

87 Background: The increasing demand for specialist palliative care (PC) in cancer care requires an available and responsive clinical workforce. But as the volume of work expands, PC providers face an increased risk of burnout, characterized by depersonalization and work-related emotional exhaustion. The prevalence and predictors of burnout among PC providers is poorly understood. Methods: Members of the American Academy of Hospice and Palliative Medicine (e.g. advanced practice provider, registered nurses, chaplains) completed the Maslach Burnout Inventory (MBI) via electronic survey in the second half of 2013; respondents were recruited via e-mail, blog and Facebook posts, and Twitter tweets. The MBI determine burnout severity across two domains, Emotional Exhaustion (EE) and Depersonalization (DP). Severity is reported as “low”, “moderate”, or “high”; “high” is consistent with burnout. Demographic and work-related variables associated with burnout in other studies were determined via stepwise logistic regression. Results: We received surveys from 1,241 clinicians. We estimated a response rate of 30%. 68% of respondents were physicians. Most respondents were over age 50 (57%), female (65%), were married or partnered (82%) and had worked in the field for less than 10 years (67%). 42% took overnight call regularly, 30% reported working 50 hours per week or more, and 57% had at least 4 colleagues. Regarding burnout, 24% reported high DP, 59% reported high EE, and 62% of reported high burnout symptoms on either EE or DP scales. In logistic regression, younger physicians, those working more than 50 hours per work, and those with fewer colleagues within their practice were at greatest risk of burnout (p<0.02). Conclusions: PC clinicians report a burnout rate of 62%. Even with the limitations of our methods and potentially biased sampling, this prevalence is remarkable and higher than data reported in medical oncology (45%). Burnout severity is associated with working in isolation and working longer hours. Further studies on how burnout affects sustainability of the PC workforce are needed, especially since this workforce is so critical to the provision of high quality cancer care.
Perceptions of palliative care among hematologic malignancy specialists: A mixed-methods study.
Authors: LeBlanc Thomas William , O'Donnell Jonathan David , Crowley-Makota Megan , Dohan Daniel Paul , Rabow Michael W. , Smith Cardinale B. , White Douglas B , Tiver Greer A , Arnold Robert , Schenker Yael 
Published: February 2017

9 Background: Patients with hematologic malignancies have unmet palliative care needs but are less likely to receive specialist palliative care services than patients with solid tumors. This difference is poorly understood. Methods: Multisite, mixed-methods study to understand and contrast perceptions of palliative care among hematologic oncologists and solid tumor oncologists. Between February and October 2012, oncologists at 3 academic medical centers with well-established palliative care services completed surveys assessing referral practices and in-depth, semi-structured interviews about their views of palliative care. We compared referral patterns using standard statistical methods. We then analyzed qualitative interview data using constant comparative methods to explore reasons for observed differences. Results: Among 66 interviewees, 23 oncologists cared exclusively for patients with hematologic malignancies, and 43 treated only patients with solid tumors. Seven of 23 hematologic oncologists (30%) reported never referring a patient to palliative care; all solid tumor oncologists had previously referred (p<0.001). In qualitative analyses, most hematologic oncologists viewed palliative care as end-of-life care, while most solid tumor oncologists viewed palliative care as a subspecialty that could assist with complex cases and/or offload burden in a busy clinic. Solid tumor oncologists emphasized practical barriers to palliative care referral, such as appointment availability and reimbursement issues. Hematologic oncologists emphasized philosophical concerns about palliative care referrals, including different treatment goals, responsiveness to chemotherapy, and a preference to control palliative aspects of patient care. Conclusions: Most hematologic oncologists view palliative care as end-of-life care, while solid tumor oncologists more often view palliative care as a subspecialty for co-managing complex patients. Efforts to integrate palliative care into hematologic malignancy practices will require solutions that address unique barriers to palliative care referral experienced by hematologic oncologists.
Early adulthood body mass index, cumulative smoking, and esophageal adenocarcinoma survival.
Authors: Spreafico Anna , Coate Linda E. , Shen Xiaowei , Zhai Rihong , Xu Wei , Chen Zhen-Fei , Chen Zhuo , Patel Devalben , Brown Catherine , Kuang Qin , Boyd Kevin , Kulke Matthew , Su Li , Mackay Helen , Knox Jennifer J. , Wong Rebecca , Darling Gail , Christiani David C. , Liu Geoffrey 
Published: February 2017

10 Background: Little is known about the individual and combined effect of early-adulthood obesity and cumulative smoking on the survival of esophageal adenocarcinoma (EAC) patients. Methods: We analyzed two independent cohorts of EAC patients: 235 patients from Toronto, Canada (TO, 2006-2011) and 329 patients from Boston, USA (BO,1999-2004). Associations between early adulthood body mass index (EA-BMI) and smoking with overall survival (OS) were assessed using Cox proportional hazard models, adjusted for stage, treatment, and other relevant covariates. Results: Median age (range) for TO dataset was 64(29-88)yrs; for BO dataset, 64(21-91)yrs. Males comprised 86% of TO and 89% of BO datasets. 90% of TO and 98% of BO patients were Caucasians. The Median (range) for packyears was 34 (0.2-118; TO) and 34 (0.2-212; BO). The Median (range) for EA-BMI was 24(15-44; TO) and 24(15-47; BO). Median BMI 1 yr prior to diagnosis was 25(16-43; TO) and 25(20-49; BO). 92% of TO and 88% of BO patients had ECOG 0 or 1. Disease stage distribution (early/locally-advanced/metastatic) was 11%/64%/25% (TO) and 30%/52%/18% (BO). For TO, the aHR for smoking was 1.03 (95%CI: 1.02-1.04; p=8E-08) per packyear, while for BO, smoking also independently conferred worse OS, with aHR of 1.007 (95%CI: 1.002-1.01; p=0.003) for each packyear increase. The aHRs for being underweight (EA-BMI<18.5), overweight (EA-BMI 25-30), and obese (EA-BMI>30) in early adulthood were 2.19 (95%CI: 1.0-4.6), 1.89 (95%CI:1.2-3.0), and 2.49 (95%CI:1.5-4.2), respectively for the TO dataset (global p=0.003 for EA-BMI). In BO, the corresponding values were 1.30 (95%CI: 0.8-2.2), 1.45 (95%CI: 1.0-2.5), and 2.39 (95%CI:1.5-3.8), respectively (global p=0.002). In contrast, BMI at one year prior to diagnosis had no association with OS in either study. Conclusions: Elevated BMI in early adulthood and heavy cumulative smoking history are independently associated with increased mortality risk in two North American EAC populations. These survival differences may reflect comorbidity differences, biological differences or both, and offer insight into how key modifiable behaviors in prevention can also affect cancer prognoses. AS, LC, DCC and GL contributed equally.
Effect of body mass index on operative complications after robotic-assisted Ivor-Lewis esophagogastrostomy: Retrospective analysis of 133 cases at a single high-volume tertiary care center.
Authors: Thau Matthew R. , Strom Tobin Joel Crill , Almhanna Khaldoun , Saeed Nadia , Hoffe Sarah E. , Shridhar Ravi , Karl Richard C. , Meredith Kenneth L. 
Published: February 2017

109 Background: The impact of body weight on robotic-assisted surgical morbidity has not been studied in esophageal cancer. We thus examined operative outcomes in patients according to their body mass index (BMI) following robotic-assisted Ivor-Lewis Esophagogastrostomy (RAIL) at a high-volume tertiary-care referral cancer center and evaluated the safety of robotic surgery in patients with an elevated BMI. Methods: We retrospectively studied patients who underwent RAIL for pathologically confirmed malignancy in the distal esophagus and assessed morbidity and intraoperative outcomes relative to BMI. We evaluated operative complications from surgery to discharge, including average operating time, estimated blood loss (EBL), pneumonia, atrial fibrillation, pulmonary embolism, deep vein thrombosis, wound infection, and surgical leaks. Median ICU days after surgery and 30 day operative mortality was assessed. Wilcoxon Rank-Sum and Spearman Coefficient were used. Results: Of 134 total patients, 106 were male and 28 were female, with an average age of 67 years. Among patients, 76% (N=102) received neoadjuvant therapy. According to BMI, 3 patients were underweight, 35 were normal weight, 62 were overweight, and 34 were obese. All patients had R0 resection, with a median of 19 lymph nodes removed. Among evaluated surgical complications, anastomotic leak rate was significantly higher in patients with high BMI (p=0.01). Median operating time was 407 mins and EBL was 150cc. High BMI was significantly associated with increased operation time and EBL (p=0.01 & p=0.05, respectively). Conclusions: This retrospective study shows that patients with distal esophageal cancer and an elevated BMI undergoing RAIL have increased operative times and EBL during the procedure. An elevated postoperative risk for anastomotic leak also exists and must be carefully monitored. However, BMI does not affect the quality of oncological resection as determined by the number of harvested lymph nodes and rates of R0 resection, suggesting similar outcomes irrespective of BMI among all patients undergoing RAIL at a high volume tertiary center.
Phase II trial of S-1 plus split cisplatin (SSP) in patients with advanced gastric cancer (HGCSG0702): Final report.
Authors: Yuki Satoshi , Komatsu Yoshito , Fukushima Hiraku , Sasaki Takahide , Kobayashi Yoshimitsu , Harada Kazuaki , Dazai Masayoshi , Sogabe Susumu , Miyagishima Takuto , Ishiguro Atsushi , Takahata Takenori , Sato Atsushi , Kudo Mineo , Kato Sosuke , Kato Kanji , Iwanaga Ichiro , Ehira Nobuyuki , Uebayashi Minoru , Sakata Yuh 
Published: February 2017

113 Background: On the basis of SPIRITS trial, S-1 plus cisplatin has been regarded as standard first-line chemotherapy for patients with advanced gastric cancer (AGC) in Japan (Koizumi W, et al. Lancet Oncol, 2008). However, conventional S-1 plus cisplatin (60mg/m2) regimen requires hospitalization for hydration. Therefore, we conducted phase II trial of S-1 plus split Cisplatin (SSP) for outpatient chemotherapy. Methods: Eligibility criteria included pathologically confirmed AGC; no prior chemotherapy; Age 20 to 75, ECOG performance status (PS) of 0 to 1; adequate organ function; and written informed consent. S-1 (40 mg/m2) was given orally, twice daily for 21 days, and cisplatin (30 mg/m2) was given intravenously on day 1 and 15, followed by 2-week rest period, within a 5-week cycle. Primary endpoint was the response rate (RR), and secondary endpoints were progression-free survival, overall survival, safety profile, and non-hospitalized survival. Results: Between Mar 2008 and Mar 2012, 40 pts were enrolled. Patients characteristics were as follows: median age 63 years (range 41-75), Male: female 30:10, PS 0:1 33:7, diffuse: intestinal 23:17. Median number of cycles was 3. The main grade 3-4 AE were neutropenia (37.5%), anemia (30%), anorexia (30%) and fatigue (15%). These toxicities were safely managed. The median relative dose intensity of S-1 was 0.782, and cisplatin was 0.824. Response rate was 57.5% (95%CI 42.2-72.8%) and disease control rate was 90.0%. Median progression-free survival was 6.1 months (95%C.I. 3.0-9.1 months) and median survival time was 15.8 months (95%C.I. 12.7-18.8 months). Conclusions: SSP showed comparable tolerability and efficacy to SPIRITS trial. In addition, most patients underwent the treatment without hospitalization. SSP may be one of practical alternatives for AGC.