bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of an initial supportive oncology clinic visit on hospitalizations and emergency department visits.
Authors: Curseen Kimberly A. , Gunter Debbie , Harrell Gwendolynn , Prizer Lindsay Penny , Moulia Danielle , Quest Tammie E. 
Published: February 2017

150 Background: Hospitalizations and emergency department (ED) visits can be frequent, costly and discordant with stated goals-of-care for cancer patients. Little is known about the impact of outpatient palliative care and supportive oncology on hospitalizations and ED visits. Our aim was to investigate the impact of an initial visit at an outpatient supportive oncology clinic (SOC) on patient hospitalizations and ED visits. Methods: New patients were referred to a SOC from our health system’s oncologists from November 1, 2014 through January 31, 2015. Visits include a structured symptom assessment and personalized treatment plan from the clinic’s physician and/or nurse practitioner. Data were collected 90 days retrospectively and 90 days prospectively from 134 consecutive initial SOC visits. Descriptive statistics were calculated. We used the Wilcoxon signed rank test to compare the mean number of hospitalizations and ED visits in the 90 days prior and 90 days post a patient’s first SOC visit. Results: Mean patient age at first SOC visit was 55.6 (SD = 16.4). 51.2% of patients were female. The most common cancers were breast, lung, head and neck. Mean number of hospitalizations per patient was significantly (p < 0.05) decreased: 1.3 (SD = 1.6) in the 90 days prior to initial SOC visit vs. 0.7 (SD = 0.7) in the 90 days post initial SOC visit. There was a non-significant reduction in mean ED visits per patient: 0.9 (SD = 0.9) in the 90 days prior to initial SOC visit vs. 0.7 (SD = 0.7) in the 90 days post initial SOC visit. Conclusions: Hospitalizations were significantly decreased and ED visits were reduced after the first visit to a small-scale SOC. This provides evidence that outpatient supportive care including aggressive symptom management may reduce patient crises, preventing ED visits and hospitalizations, and will likely lead to cost savings and improve quality of life for patients during and after cancer therapy. The decrease in hospitalizations and ED visits may be underestimated if disease was progressing and overestimated if disease was shrinking, but this data was not available for this study.
Validation of the "surprise question" in gynecologic oncology: Comparing physicians, advanced practice providers and nurses.
Authors: Lefkowits Carolyn , Chandler Chelsea , Sukumvanich Paniti , Courtney-Brooks Madeleine , Duska Linda R. , Althouse Andrew , Kelley Joseph L 
Published: February 2017

151 Background: The “surprise question” – “Would you be surprised if this patient died in the next year?” has been validated in non-gynecologic cancer as highly predictive of 12-month mortality. It has been used as a major inclusion criterion in studies showing benefit to specialized palliative care. It has not been studied in the gynecologic oncology (GO) population or with non-physician providers. Our objectives were to (1) evaluate the prognostic significance of the surprise question in GO patients and (2) compare the performance of the surprise question among different provider groups. Methods: The surprise question was asked of a group of 18 GO providers from a single academic institution (7 physicians, 7 advanced practice providers (APP) and 4 chemotherapy nurses (RN)) regarding their patients currently receiving radiation or chemotherapy. Demographic and clinical data were abstracted from chart review and mortality data was collected 12 months later. Results: The 263 patients included had a median age of 64 and the majority were white (94%). The most common cancer was ovary (50%), 58% had stage III/IV disease and 46% had recurrent disease. There were 54 deaths (20.5% one-year mortality). Risk of mortality was significantly higher for patients with a response of “No” to the surprise question from the MD (40% vs 10.6%, p < 0.01), APP (43.2% vs 7.6%, p < 0.01) and RN (50.8% vs 13.1%, p < 0.01). The unadjusted odds ratio for death within a year associated with a “No” answer to the surprise question by provider were as follows: MD OR 5.6 (p < 0.001), APP 9.21 (p < 0.001), RN 6.86 (p < 0.001). The APP group had the highest sensitivity (79.5%), while the RN group had the best specificity (75.6%). Conclusions: The surprise question is a simple, feasible and effective tool to identify patients with gynecologic cancer who have a greatly increased risk of 12-month morality when administered by physicians, advanced practice providers or chemotherapy nurses. This one question screen could be used to identify patients appropriate for early referral to specialized palliative care or patients in whom to consider initiating conversations about goals of care and advanced care planning.
Trends in health care utilization, cost, and aggressive care at end of life among older cancer patients in the Deep South.
Authors: Kvale Elizabeth Ann , Rocque Gabrielle , Bevis Kerri S. , Acemgil Aras , Taylor Richard A. , Demark-Wahnefried Wendy , Kenzik Kelly , Li Yufeng , Meneses Karen , Martin Michelle , Fouad Mona N. , Pisu Maria , Partridge Edward E. 
Published: February 2017

155 Background: Healthcare utilization and costs escalate near diagnosis and in the final months of life. There is a national trend toward aggressive care at end of life (EOL). We examined patterns in utilization and cost across the trajectory of care and during the last two weeks of life during implementation of a lay navigation intervention. Methods: Claims data were obtained for Medicare beneficiaries ≥ 65 years old with cancer in the UAB Health System Cancer Community Network (UAB CCN). For 10 quarters from January 2012 -June 2014, we examined healthcare utilization for the population at large, navigated patients, and decedents. All analyses included ER visits, hospitalizations, and ICU admissions and use of chemotherapy in the last 2 weeks of life, and hospice utilization (admission or less than 3 days of hospice) in the quarter of death for decedents. Descriptive analyses and linear regression were used to test trends over time; general linear models evaluated changes in health care utilization and cost. Results: Across the population reduction of 13.4% to 11% for hospitalization (18% decrease, p < 0.01), 8.0% to 7.1% for ER visits (12% decrease, p < 0.01), 2.9% to 2.5% for ICU admissions (14% decrease, p = 0.04) and an increase of 3.9% to 4.3% for hospice (9.2% increase p = 0.37) were found. Among 5,861 decedents, in the last 2 weeks of life, there were decreases in ICU admissions (14.6% decrease, p = 0.11), from 39.2% to 32.0%, ER visits (18.4% decrease, p = 0.03), and chemotherapy, from 4.7% to 3.5% (25.5% decrease, p = 0.11).Over the 10 quarters, hospice enrollment increased from 70.7% to 77.4% (9.48% increase; p = 0.06), and the proportion of patients on hospice for less than 3 days changed from 7.8% to 7.5% (3.85% decrease, p = 0.30). Costs decreased about $158 per quarter per beneficiary. A significant pre-post decrease of $952 per beneficiary (p < 0.01) led to an estimated reduction in Medicare costs of $18,406,920 for the 19,335 beneficiaries in the UAB CCN for the five quarters post-implementation. Conclusions: We observed decreased healthcare utilization and cost and trends toward decreased aggressive care at EOL in the UAB CCN. Further work is needed to determine the impact of navigation on utilization trends.
The impact of a one month palliative care rotation on medical residents working in a tertiary cancer center in Jordan.
Authors: Shamieh Omar M. , Alawneh Alia , Ahamd Wafa , Salmany Sewar S , Altamimi Barakat , Alkam Hamzah , Dibs Khaled Nabil , Mallah Osama , Ammar Khawla , Turfa Rim , Abdel-Razeq Hikmat , Hui David 
Published: February 2017

168 Background: Palliative care education and training remains inadequate for medical professionals especially in developing countries. We evaluated the impact of a one month palliative care clinical rotation on medical residents’ attitude, competency, and knowledge related to palliative care in a tertiary cancer center in Jordan. Methods: All transitional Internal Medicine residents rotated in a monthly palliative care rotation at King Hussein Cancer Center (KHCC), in Amman, Jordan, were requested to participate in this educational intervention study. A concise curriculum in palliative and end of life care, adapted from the Education for Physicians on End-Of-Life Care (EPEC) Curriculum and delivered by our faculty was piloted as a part of the clinical rotation. Residents spent one month in the inpatient palliative care unit, in addition to 10 hours of classroom interactive sessions. The curriculum comprised of five modules: 1- Principles of palliative care, 2- Pain management, 3- Management of distressing symptoms, 4- Communication skills, 5- End-of- life care. To assess our educational outcomes, we adapted a previously developed instruments by David Weisman and used by the National Residency Education in the United States. All Instruments were completed by each resident before and after the rotation, and included self-assessment of attitude, competency and a knowledge test comprising of 32-items of multiple choice questions. Results: Twenty of 27 (74%) residents who started the palliative care rotation completed the required education and had paired evaluations. There was improvement in all three instruments: 37% improvement in competence (p < 0.0001), 17% Improvement in knowledge (p = 0.015), and 5% improvement in attitude (p = 0.02). Conclusions: The one-month mandatory rotation improved knowledge, attitude and competence related to palliative care for medical residents.
Leaning upon international directives for optimization: Anemia—Results of the French Lidoanemia-2 Survey.
Authors: Launay-Vacher Vincent , Janus Nicolas , Ludwig Lisa , Deray Gilbert , Scotte Florian 
Published: February 2017

180 Background: Anemia in cancer patients is common. The LIDOANEMIA-1 survey [Scotté F. MASCC 2015] reported that French clinicians do not follow EORTC guidelines. We aimed at improving EORTC guidelines dissemination among French physicians (FP). This second survey aimed at assessing the impact of our initiative on physicians’ behavior. Methods: Declarative survey conducted in France. The intervention consisted of having physicians watch a short video summarizing EORTC guidelines and their main messages for clinical practice. Evaluation of the impact of the intervention was performed with a 4-question web-based form FP filled in after seeing the video. Results: 319 FP answered the survey. Results are showed in the Table regarding the 4 main items: anemia diagnosis, Hb cut-off for considering RBC transfusion or ESA initiation, and Target Hb level on treatment. Among FP who were not following the guidelines, 67.7, 38.2, 50.8 and 65.2% declared they will follow them after the intervention, respectively for anemia diagnosis, Hb cut-off for considering RBC transfusion or ESA initiation, and Target Hb level on treatment. After the intervention, the expected proportion of FP who will follow EORTC guidelines is 93.2, 69.4, 82.6, and 89.4%, respectively for each item evaluated. Conclusions: Dissemination of guidelines is key to improve patient care. We tested a simple mean of presentation of EORTC guidelines in anemia management in cancer patients which significantly increased the proportion of FP who declare they will follow the guidelines. However, a non-negligible proportion of them does not agree and will not follow them, especially for the Hb cut-off for considering RBC transfusion. [Table: see text]
The Opioid Rotation Ratio (ORR) to transdermal fentanyl (TDF) in cancer patients.
Authors: Reddy Akhila Sunkepally , Haider Ali , Tayjasanant Supakarn , Wu Jimin , Liu Diane D , Yennu Sriram , De la Cruz Maxine Grace , Vidal Marieberta , Reddy Suresh K. , Bruera Eduardo 
Published: February 2017

181 Background: Cancer patients frequently undergo opioid rotation (OR) for uncontrolled pain or opioid induced neurotoxicity. TDF is one of the most common opioids prescribed to cancer patients. However, the accurate ORR from other opioids to TDF is unknown and various currently used methods result in a wide variation of ORRs. Our aim was to determine the ORR of morphine equivalent daily dose (MEDD) to TDF when correcting for MEDD of breakthrough opioids (net MEDD) in cancer outpatients. Methods: We reviewed records of 22,532 consecutive patient visits at our Supportive Care Center in 2010-13 for OR from to TDF by a palliative medicine specialist. Data regarding Edmonton Symptom Assessment Scale (ESAS) and MEDD were collected in patients who returned for follow up within 5 weeks. Linear regression analysis was used to estimate the ORR between TDF dose and net MEDD (MEDD prior to OR minus MEDD of breakthrough opioid used along with TDF after OR). Successful OR was defined as 2-point or 30% reduction in pain score and continuation of the new opioid at follow up. Results: 129 patients underwent OR to TDF from other opioids. The mean age was 56 years, 59% male, and 88% had advanced cancer. The median time between OR and follow up was 14 days. Uncontrolled pain (80%) was the most frequent reason for OR and 59% had a successful OR with significant improvement in ESAS pain, constipation, and symptom distress scores. In 101 patients with OR and no worsening of pain at follow up, the median ORR (range) from net MEDD to TDF mg/day was .01 (-0.02-0.04) and correlation of TDF dose to net MEDD was .77 (P < .0001). The ORR was not significantly impacted by variables such as mucositis, serum albumin, and body mass index (BMI). The ORR of .01 suggests that MEDD of 100mg is equivalent to 1mg TDF/day or 40mcg/hour TDF patch (1000mcg/24hours). Conclusions: The median ORR from MEDD to TDF mg/day is .01 and the ORR from MEDD to TDF mcg/hour patch is 0.4. Further validation studies are needed. [Table: see text]
Breathlessness and opioid therapy: A retrospective chart analysis in 2,958 patients.
Authors: Gronwald Benjamin , Wolff Michael , Gaertner Jan , Bialas Patric , Niewald Marcus , Schmitz Andrea , Faehndrich Sebastian , Gottschling Sven 
Published: February 2017

192 Background: Breathlessness is a common and distressing symptom, which increases in many diseases as they progress and is difficult to manage. It is widely accepted that opioids are safe and effective for treating dyspnea, although no single opioid has an authorization for the treatment of breathlessness. The aims of the study were to assess prevalence rates of breathlessness as well as the treatment approaches especially with respect to opioid therapy in all patients cared by a hospital palliative care team in a university hospital over a period of five years. Methods: A systematic review of all electronically available records of patients under palliative care service from April 2010 – April 2015 was performed. Results: Breathlessness was the third most common symptom in our patient group behind fatigue and pain. Furthermore it was classified as the utmost distressing symptom of all. Many patients suffering from breathlessness were opioid-naive before contact with our palliative care team. Many of these patients were put on prolonged-release opioids together with short-acting opioids (mucosal fentanyl) as rescue medication for breathlessness. Opioid therapy was judged to be very effective by the majority of patients suffering from breathlessness however caused (cancer-related or due to a benign disease e.g. chronic obstructive pulmonary disease). Conclusions: In a large cohort of patients breathlessness is a major topic and is clearly positively influenceable by opioids. In our opinion it is longtime overdue to strive for an authorization for opioids against breathlessness.
A placebo-controlled trial of aprepitant for cough in lung cancer.
Authors: Harle Amelie Sylvia Mary , Smith Jaclyn A , Molassiotis Alex , Lofthouse Kimberley , Dockry Rachel , Russell Philip , Burns Katy , Blackhall Fiona Helen 
Published: February 2017

2 Background: There are no evidence-based therapies for cough in lung cancer (LC).The neurokinin-1 (NK-1) pathway is implicated in cough. Aprepitant is an NK-1 antagonist used as an antiemetic. We assess aprepitant as an antitussive, using objective daytime ambulatory cough monitoring (ACM) as the primary endpoint. Methods: LC patients with a “bothersome” cough were enrolled on an exploratory single-arm randomised double-blind crossover trial and received 125mg aprepitant on day 1 and 80mg on days 2 and 3 or matched placebo capsules. After a 3 day wash out,patients crossed over to placebo or aprepitant for 3 days (days 7-9). They completed ACM and validated subjective cough tools. Results: 20 LC patients were enrolled between 7th Oct 2013-3rd Nov 2014; mean age 66 yrs (SD 7.69); 60% (n=12) female; 70% (n=14) ex, 25% (n=5) current and 5% (n=1) never smokers respectively. 20% (n=4), 55% (n=11) and 25% (n=5) had a performance status of 0, 1 and 2 respectively. The majority (80% n=16) had non-small cell LC; half (n=10) had advanced stage; 20% (n=4) were on anticancer therapy. Daytime cough frequency was 15.9 (95%CI 10.1-28.3 n=19), 12.8 (95% CI 8.7-18.8 n=18) and 16.2 (11.3-23.0 n=19) coughs/hr at baseline, on aprepitant and on placebo respectively: p=0.03. Visual analogue scale scores (range 0-100, high score=worse severity) were 57.0mm (95% CI 47.4-67.2 n=19), 40.8mm, (95%CI 34.3-47.3 n=18), and 49.8mm (95%CI 44.2-55.4 n=19) at baseline, on aprepitant and on placebo respectively: p=0.008. The Manchester Cough in Lung Cancer Scale score (range 1-50, high score = worse cough impact) was 25.2 (95%CI 23.0-28.0 n=19), 19.5 (95%CI 17.8-21.2 n=18) and 21.7 (20.3-23.1 n=18) at baseline, on aprepitant and on placebo respectively: p<0.001.There were no serious adverse events. Conclusions: This is the first trial to assess the efficacy of a novel antitussive using validated subjective and objective cough tools in LC and the first to investigate a centrally acting NK-1 antagonist in humans. Aprepitant treatment was associated with statistically significant improvements in objective and subjective scores. The NK-1 receptors may be key mediators in cough in LC. It is possible to run a robust trial using validated measures with clinically meaningful endpoints in a LC population. Clinical trial information: ISRCTN16200035.
Survival comparison of patients treated with one versus five fraction palliative radiotherapy.
Authors: Dudley Sara , Qian Yushen , Chaudhuri Aadel , Kumar Kiran , Aggarwal Sonya , Chang Daniel Tandel 
Published: February 2017

200 Background: Choice of fractionation scheme for palliative radiotherapy has received greater attention in recent years, particularly in the current healthcare environment where issues of cost and quality of life have taken on increasing importance. The ASTRO Choosing Wisely campaign recommends against routine use of extended fractionation schemes ( > 10 fractions) for palliation of bone metastases given equivalent pain relief between 30 Gy in 10 fractions and 8 Gy in 1 fraction, and strong consideration for use of 8 Gy in 1 fraction is urged for patients with a limited prognosis or transportation difficulties. We investigated whether there was a difference in survival between patients treated with an intermediate fractionation scheme (5 fractions) and patients who received single-fraction treatment. Methods: We identified 220 patients who received a total of 264 courses of palliative radiotherapy with either 8 Gy in 1 fraction (n = 91) or 20 Gy in 5 fractions (n = 173). Date of death was obtained from either the patient’s medical record, the Social Security Death Index, or publicly available obituaries. If none of these yielded a date of death, patients were censored at the date of their last clinical encounter. The majority of patients (n = 192) were treated for bone metastases. All primary sites were included, with the three most common histologies being lung, breast and prostate (n = 80, 31 and 16, respectively). Results: Overall, we found no significant survival difference between the two groups. Patients treated with 8 Gy in 1 fraction had a median survival of 146 days, whereas patients treated with 20 Gy in 5 fractions had a median survival of 183 days (p = 0.43). Conclusions: Given no difference in survival between fractionation schemes of 20 Gy in 5 fractions and 8 Gy in 1 fraction, delivery of palliative radiation in a single fraction should be strongly considered. Previous studies have identified a higher re-treatment rate in single-fraction treatments, although closer analysis of this data revealed no difference in absolute pain scores prior to re-treatment. Thus, re-treatment for single-fraction radiotherapy may be due instead to a greater clinical willingness to re-treat as opposed to a greater clinical need.
Netupitant/palonosetron (NEPA) for prevention of delayed chemotherapy-induced nausea and vomiting (CINV) in multiple cycles of chemotherapy.
Authors: Schwartzberg Lee Steven , Gralla Richard J. , Kashef Kimia , Rugo Hope 
Published: February 2017

211 Background: Prevention of CINV in the delayed phase (24-120 h post-chemotherapy) and over multiple cycles of chemotherapy remains a challenge. NEPA, a fixed combination of the NK1 receptor antagonist (RA) netupitant (300 mg) and the 5-HT3 RA palonosetron (PALO; 0.5 mg), has demonstrated efficacy in multiple studies, in both acute and delayed phases, during the first cycle of moderately or highly emetogenic chemotherapy (MEC and HEC, respectively) regimens. Two clinical trials evaluated NEPA over multiple cycles of chemotherapy. We report data for the delayed phase for each cycle. Methods: Both studies were Phase 3, double-blind, active-controlled studies. In study 1 (MEC), patients were randomized 1:1 to receive a single oral dose of NEPA (n = 724) or PALO 0.5 mg (n = 725) on Day 1; following cycle 1, patients could participate in a multi-cycle extension phase. In study 2 (MEC or HEC), patients were randomized 3:1 to receive a single oral dose of NEPA on Day 1 (n = 309) or oral aprepitant (APR) 125 mg plus oral PALO 0.5 mg on Day 1, then APR 80 mg/d on days 2 and 3 of each cycle (n = 103). In both studies, all patients also received dexamethasone. Efficacy endpoints included complete response (CR; no emesis, no rescue medication) and no significant nausea. Results: In both studies, CR rates were consistently numerically higher with NEPA (Study 1 range: 77%-89%; Study 2 range: 83%-93%) than with PALO (Study 1; range: 69%-83%) or APR/PALO (Study 2; range: 78%-88%) in each cycle up to cycle 6 (Table). In both studies, rates of no significant nausea in the NEPA group were similar to or higher than in the control group. NEPA was well tolerated in both studies; treatment-related adverse events included constipation and headache. Conclusions: These studies demonstrate sustained efficacy of NEPA (administered as a single dose on Day 1) across multiple cycles of MEC or HEC for prevention of CINV in the delayed phase. Clinical trial information: 2009-016775-30; 2010-023297-39. [Table: see text]