bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of palliative care referral on hospice enrollment: A single center analysis.
Authors: Sinha Shreya , Basnet Alina , Syed Wajihuddin , Koparthy Pallavi , Khan Rashad , Madhira Bhaskara Reddy , Huang Danning , Lemke Sheila M. 
Published: November 2017

17 Background: Despite ASCO’s recommendation to introduce palliative care services for all patients diagnosed with localized or metastatic pancreatic cancer, most patients’ care does not involve this multimodality approach. Transitioning patients to hospice at an appropriate time is essential in oncologic practice. The purpose of this study is to identify which variables affect acceptance of hospice services by patients. Methods: A retrospective chart review of patients with pancreatic cancer treated at Upstate University Hospital from 2011-2015 was performed. We studied variables including age, sex, race, stage, insurance status, advance directives, performance status and laboratory values. We analyzed patients based on acceptance or rejection of hospice care in their disease course and conducted a univariate analysis on different factors to determine predisposing variables. p-values were calculated using Chi-Square test and t-test. Results: We reviewed 325 patients charts and found statistically significant relation to acceptance of hospice and insurance status, and involvement of palliative care in their care. Patients with Medicare were more likely to decline hospice care whereas patients with Medicaid or no insurance were more likely to accept it. 36.23% of patients saw palliative care services at any point in their treatment course and these patients were more likely to accept hospice care than patients who did not (p = < 0.0001). Patients who were seen by palliative care earlier in their disease course were more likely to accept hospice care, although this did not reach statistical significance (p = 0.0731). Patients with stage IV disease were more likely to accept hospice care (p = 0.0095). Other variables like presence of advanced directives, tumor markers, age, and sex did not have a significant impact. Conclusions: Palliative care involvement is beneficial in patients with pancreatic cancer as they face a rough disease course with multiple treatment and disease related morbidities. Patients with early palliative care involvement during their illness are more likely to decide on hospice care at the end stages of their malignancies. This supports early palliative care introduction as an adjunct to oncologic care.
Development of a Prompt Radiation Oncology Mediated Palliative Treatment (PROMPT) program for handling urgent cases at an academic hospital.
Authors: Robbins Jared R. , Shukla Monica , Bedi Manpreet , Johnstone Candice Aitken 
Published: November 2017

173 Background: Oncology inpatients frequently need urgent palliative radiation therapy (RT). Evaluating and treating these unscheduled patients adds challenge and stress to all members of the radiation oncology team. To efficiently and compassionately address these situations, and ensure prompt, evidence-based, quality treatment, we developed the PROMPT program. This included scheduling designated consult slots for emergencies, adding flexible CT simulation times, assigning palliative-specific dosimetrists, and engaging support staff to improve workflow. The purpose of this project was to evaluate the PROMPT program with various quality metrics and identify areas for further improvement. Methods: Patient data from inpatient encounters for academic year 2016-2017 (July 1, 2016 to June 30, 2017) were reviewed. The day of the consultation, reason for consult, date of simulations, and dose fractionation were recorded. Time from consult to simulation, and treatment initiation were calculated. Results: A total of 270 inpatient consults (199 new and 71 established) were evaluated. During the inpatient stay, 141 CT simulations and 121 verification simulations were performed. For those treated with palliative intent, 87% were simulated within one day of consult (72% same day, 15% next day). The median time from consult to the start of treatment was 1 day with 56% starting treatment within 1 day and 75% within 3 days. The most common reasons for RT were bone metastases (30%), brain metastases (19%), airway obstruction (15%), soft tissue masses (11%), and spinal cord compression (7%). For bone metastases, the median time from consult to end of treatment was 6 days with hypofractionated regimens being commonly employed in 86% (55% received 20 Gy in 5 fractions, and 31% received single fraction). Of those that started RT as inpatients, 13% stopped prior to completion, usually to enter hospice. Conclusions: The PROMPT program provided rapid identification of patients requiring palliative RT and an effective and efficient path from consultation to treatment. Implementing similar programs at other centers could facilitate improved care of palliative patients.
Effect of creative writing on mood in cancer patients.
Authors: Hussain Muhammad Azam , Zhu Junjia , Drabick Joseph , Joshi Aditya , Saunders Erika , Truica Cristina I. , Hayes Michael , Joshi Monika 
Published: November 2017

178 Background: Patients with cancer may have significant mental health comorbidity. Creative writing has a substantial history in providing a wide range of psychological benefits for cancer patients. Methods: We conducted a pilot study to determine feasibility whether cancer patients can be enrolled, randomized and retained for four weeks for creative writing classes (Feasibility was defined as 50% of our enrolled patients on intervention arm (IA) could attend at least 2 classes). We anticipated enrolling 45 patients over the period of 2 months with randomization into 2 arms: IA and standard of care (SOC). “Write from the Heart”, a series of creative writing workshops (CWW) were conducted on IA. Subjects in IA had four, 2-hour weekly CWW whereas SOC arm did not receive any sessions. We used validated Emotional Thermometer Scales (ETS), ranging from 0 (best)-10 (worst), to predict changes in parameters reflecting patient’s mental health pre and post intervention. ETS has five dimensions (distress, anxiety, depression, anger and need help), which are all continuous variables. Results: Total of 16 patients were accrued -11 in IA and 5 in SOC. 7 out of 11 (63%) patients enrolled in IA attended at least 75% of classes. Comparisons were made using two-sample T-tests. Although sample size was small, analysis showed intriguing results. IA did show a decreasing pattern on Total Emotion Score (TES). For each visit, post-class scores were lower than pre-class scores. SOC versus IA and IA intragroup analysis (Paired T-test) did not reveal any statistical significance. Conclusions: We observed that it is feasible for cancer patients to attend focused workshops geared towards mental health wellbeing. Although not statistically significant, IA showed trend towards mood improvement. A second study is planned with a single arm for all cancer patients. In addition to using emotional thermometers, we will include questionnaires to evaluate mental health symptoms effectively. Further prospective clinical studies should be conducted to evaluate effect of this intervention in cancer patients. Clinical trial information: Study 00006541. [Table: see text]
Couple-based mind-body intervention for patients with metastatic lung cancer and their spouses.
Authors: Milbury Kathrin , Engle Rosalinda , Liao Zhongxing X. , Tsao Anne S. , Owens April , Bruera Eduardo , Cohen Lorenzo 
Published: November 2017

179 Background: Given the incurable nature of metastatic lung cancer, patients and their spouses are at risk of experiencing psychological and spiritual distress. To address these concerns, we developed a couple-based mind-body (CBMB) intervention. This formative research aimed to examine intervention acceptability and initially efficacy in patients with metastatic lung cancer undergoing treatment and their spouses. Methods: We first conducted focus groups followed by a single-arm trial. Focus group participants completed program exercises and then semi-structured interviews and written evaluations including Likert-scale and open-ended questions. In the single-arm trial, the four intervention session were delivered over a 2-week period focusing on cultivating mindfulness, interpersonal connection, gratitude and purpose. Couples completed measures of depressive symptoms (CES-D), cancer distress (IES), spiritual well-being (FACT-Sp) and sleep disturbances (PSQI) before and after the program. Results: Focus groups (n = 7 dyads) revealed high acceptability ratings of the CBMB intervention (e.g., all participants would recommend the intervention). Consent and adherence rates (54% and 67%, respectively) were acceptable for the single arm trial (n = 7 dyads). All patients (67% male; µ age = 55 years) and partners (33% male; µ age = 59 years) rated the intervention as useful. Paired t-test analyses revealed large effects for sleep disturbances ( d= 1.83) and medium effects for cancer distress ( d= .61) for patients and large effects for depressive symptoms for spouses ( d= .90). Conclusions: Based on this two part study, the CBMB intervention appears to be acceptable and subjectively useful. There was also preliminary evidence regarding treatment gains for both patients and partners. A randomized controlled trial is warranted to further examine this supportive care strategy.
Lost in translation: Adolescents and young adults use words of hope to express their spirituality.
Authors: Barton Krysta S. , Tate Tyler P , Rosenberg Abby R. 
Published: November 2017

185 Background: Adolescents and Young Adults (AYAs) with cancer are at risk for poor psychosocial outcomes, in part because cancer may disrupt developmental processes such as spiritual questioning. Indeed, spirituality may enable hope, meaning, and purpose, in turn facilitating the adjustment to cancer. The need to address spirituality has been established among adult patients, how to do so in an AYA age-appropriate manner has not been described. We aimed to better understand the language and perspectives of AYAs regarding spirituality. Methods: AYA patients (ages 14-25 years) were eligible if they had been diagnosed with cancer within the past 60 days. Demographic surveys including self-reported spirituality and religiousness were completed at the time of enrollment. Semi-structured, 1:1 interviews were conducted at the time of enrollment, 6-12, and 12-18 months later. Verbatim transcripts were coded by three independent coders using directed content analysis for instances of spirituality, religiosity, hope, and fear. Additional deductive analyses used a priori coding themes defined from prior conceptualizations of AYA hope: forced effort, personal possibilities, expectations of a better tomorrow, and anticipation of a better tomorrow Results: Seventeen patients completed 44 interviews with > 100 hours of transcript-data. Their mean age was 17.1 (±2.7); 8 (47%) were male, their diagnoses were sarcoma (n = 8), acute leukemia (n = 6), and lymphoma (n = 3). At enrollment 10 (58%) & 6 (35%) endorsed personal spirituality and religiousness in surveys, respectively, few verbal narratives included explicit self-identification of either construct. Further, while many AYAs denied spiritual beliefs, all of them endorsed hopes, often as a source of strength, meaning, or self-expression. Longitudinal analyses suggested an evolution of spiritual beliefs and self-identities, even when patients selected other language to describe such processes. Conclusions: AYAs with cancer are trying to work-through complex existential beliefs and questions. Often, instead of defining themselves as spiritual or religious or using explicit spiritual language, they articulate their existential feelings with the language of hope.
Engaging staff in advance care planning during National Healthcare Decisions Week at a major cancer hospital.
Authors: Emanuel Lindsay , Ito-Hamerling Gayle , Boutros Nicole , Zachariah Finly 
Published: November 2017

19 Background: In a 2014 study of US adults, “lack of awareness” was the most commonly reported reason for not having an advance directive (AD). Medical staff have opportunities to increase AD awareness for patients at key touchpoints in the cancer treatment trajectory. At City of Hope National Medical Center (COH), the Department of Supportive Care Medicine with administrative support and significant institutional collaboration created a patient-and-staff-centric Advance Care Planning program and marketing awareness campaign titled “Plan Today for Tomorrow.” Methods: Efforts were made to increase staff comfortability with and personal completion of ADs. General education was provided through staff in-services, medical grand rounds, and new employee orientation, all with opportunities to complete personal ADs. In addition, education and training were provided to staff at key patient touchpoints, including new patient services and the pre-anesthesia testing clinic. Most recently, during the 2017 National Healthcare Decisions Week, one day was tailored specifically to increasing the number of staff who have completed their own advance directive. A five dollar Starbucks incentive was made available for non-physician staff who completed their own AD. Free notary services and AD support were made available at multiple locations on the main COH campus and satellites clinics. Results: On the day dedicated to staff outreach and completion of personal ADs during the COH 2017 National Healthcare Decisions week, 109 staff members completed their own AD. Staff participants reported increased comfort with the AD conversation, relief of personal burden by completing AD, increased understanding of the document and the importance of completion, and a sense of “practicing what they preach” to patients. Conclusions: Targeted efforts to engage staff in advance care planning can be successful. Nominal incentives may be helpful to attract staff to explore advance care planning personally. Further work is needed to embed advance care planning and advance directive completion in the culture of healthcare institutions.
Inclusion of spiritual pain in patient reported outcome assessments as part of an integrative medicine physician consultation.
Authors: Lopez Gabriel , Liu Wenli , Chen Minxing , Li Yisheng , Chaoul Alejandro , Bruera Eduardo , Cohen Lorenzo , Delgado-Guay Marvin 
Published: November 2017

190 Background: Complementary and integrative health services are increasingly available to patients at cancer centers to help address physical and psychological needs. We review inclusion of spiritual pain (SP) as part of patient reported outcome (PRO) assessments in patients presenting for an outpatient integrative medicine consultation at a comprehensive cancer center. Methods: PRO data were collected as part of outpatient physician consultations at an integrative medicine clinic; we reviewed data between January 2013 and April 2017. Patients completed the Edmonton Symptom Assessment Scale (ESAS-FS, 12 symptoms, scale 0-10, 10 worst possible) immediately prior to the clinical encounter. ESAS distress subscales analyzed included psychological, physical, and global. Statistical analyses included summary statistics, two sample t-tests, correlations, and logistic regression. Results: We analyzed data from 4348 unique participants. Demographics included 65% women, average age 55.5, 78% Caucasian, 72% married or with significant other, majority Christian non-Catholic (49%) followed by non-specified (23%), and Catholic (20%). Overall, 41% of patients reported SP at baseline. Patients reporting a SP score of ≥ 1 (n = 1549) reported significantly higher levels of global, physical, and psychological distress than patients with SP scores of 0 (n = 2275) (all p’s < 0.001). Older patients and men were less likely to report SP. SP clustered with psychological symptoms of depression and anxiety (reliability coefficient 0.76). Conclusions: A significant number of cancer patients presenting for integrative medicine consultations reported having SP, with SP clustering with psychological versus physical symptoms. More research is needed to better understand how routine screening for SP contributes to assessments of overall psychological health.
A multimodal intervention to enhance sexual function and quality of life (QOL) in hematopoietic stem cell transplant (HCT) survivors.
Authors: El-Jawahri Areej , Fishman Sarah , Vanderklish Julie , Traeger Lara , Dizon Don S. , Temel Jennifer S. 
Published: November 2017

191 Background: Although sexual dysfunction is a common long-term complication in allogeneic HCT survivors, interventions to address sexual dysfunction are lacking. Methods: We conducted a pilot study to assess the feasibility and preliminary efficacy of a multimodal sexual dysfunction intervention to improve sexual function in allogeneic HCT survivors. Transplant clinicians systematically screened all HCT survivors ≥ 3 months post-HCT for sexual dysfunction causing distress using the NCCN Survivorship Guidelines. Those who screened positive attended monthly intervention visits with trained study clinicians that focused on 1) assessing sexual dysfunction; 2) educating and empowering patients to address this topic; and 3) implementing therapeutic interventions. We used the PROMIS Sexual Function and Satisfaction Measure, Functional Assessment of Cancer Therapy-Bone Marrow Transplant (FACT-BMT), and Hospital Anxiety and Depression Scale (HADS) to assess sexual function, QOL, and mood at baseline and six months post-intervention, respectively. Results: 33.1% (50/151) of patients screened positive for sexual dysfunction causing distress. 94.0% (47/50) of patients who screened positive agreed to participate. We demonstrated significant improvement in patients’ satisfaction and interest in sex as well as sexual function including orgasm, erectile function, lubrication, and vaginal discomfort [Table 1]. Six of ten patients who were not sexually active prior to the intervention became sexually active post-intervention (P = 0.031). Patients reported improvement in their QOL and a trend toward lower depression (Table). Conclusions: The multimodal intervention to address sexual dysfunction appears feasible with encouraging preliminary efficacy for improving sexual function, QOL, and mood in allogeneic HCT survivors. Clinical trial information: NCT02492100. [Table: see text]
Factors associated with lack of proper hydration in terminal cancer patients.
Authors: Bryniarski Pawel 
Published: November 2017

195 Background: Dehydration is a frequent problem in patients suffered from terminal cancer. It decreases the quality of life and increases the amount of complications. The aim of our study was to determine factors connected with dehydration in patients with terminal cancer. Methods: 310 terminal cancer patients admitted to Palliative Care Unit were retrospectively analyzed. Detailed physical examination, medical history including history taken from family and care givers was taken upon admission. Laboratory parameters including morphology, concentration of sodium, potassium, total and ionized calcium, LDH were taken on admission. Univariate and multivariate logistic regression analysis were used to determine possible predictors, symptoms and consequences of dehydration. Results: On admission 34,51% of patients were dehydrated. They had more frequently: metastases (OR = Odds Ratio = 2,77, p = probability value = 0,019), nausea and vomiting (OR = 2,234,p = 0,0176), dyselectrolytemia (OR = 2,609, p = 0,0007); had higher PS scale note (OR = 1,458, p = 0,0031); were more often cachectic (OR = 2,482, p = 0,0003); had lower albumin level (OR = 0,931 ,p = 0,0008). They had 235% higher risk of death (OR = 2,356, p = 0,0007). Multivariate logistic regression analysis after adjustment for possible confounders reviled that occurrence of: metastases (OR = 2,665, p = 0,045), cachexia (OR = 2,105; p = 0,01) and nausea and vomiting (OR = 2,727, p = 0,026) remained independently associated with dyselectrolytemia. Conclusions: Occurrence of metastases, occurrence of nausea and vomiting and occurrence of cachexia are factors associated with dehydration. Patients with lack of proper hydration had 235% higher risk of death. Project "Extension of life and improvement of its quality and reduction of cancer patients' mortality due to proper control of water and electrolytes management and elimination of risk factors for dehydration and dyselectrolytemia" co-financed by the European Social Fund under the project of the Ministry of Science and Higher Education of Poland entitled "Best of the best! 2.0".
Palliative versus nonpalliative patients’ perceptions of the effect of alcohol consumption on clinical outcomes.
Authors: McFarlane Graham , Balaratnam Karmugi , Selby Peter , Alibbhai Shabbir , Brown M. Catherine , Jones Jennifer M. , Howell Doris , Pringle Dan , Xu Wei , Liu Geoffrey , Eng Lawson 
Published: November 2017

199 Background: Little is known about the perceptions of palliative patients on the impact of continued alcohol consumption after a cancer diagnosis and whether they are similar to the perceptions of patients who are considered potentially curative. Methods: Patients with diverse cancer subtypes were surveyed at a comprehensive cancer centre, cross-sectionally. Specifically, palliative and non-palliative cancer patients were asked about their perceptions on the benefits/harms of continued drinking on cancer-related quality of life, fatigue, and overall survival, and whether they had received information on their alcohol consumption from their health care providers. Palliative status was established by chart review. Results: Of 1049 patients, 48% were male, with median age of 58 (18-98) years; cancer sites included gastrointestinal, genitourinary, breast, thoracic, hematologic, and others; 16% were classified as being palliative at the time of survey; and 14% reported receiving counselling information on alcohol use sometime after their cancer diagnosis. Compared to curative patients, palliative patients were more likely to perceive continued alcohol consumption as harmful to their fatigue (OR=1.39, P=0.05) and survival (OR=1.45, P=0.03), but less so on quality of life (OR=1.16, P=0.35). When compared to those who had not been counselled, informed patients were twice as likely (OR=2.01, P<0.01) to perceive continued drinking as harmful to their levels of fatigue, although there was less of a difference in their perception of quality of life (OR =1.39, P=0.20) and survival (OR=1.40, P=0.19). Conclusions: Palliative patients are more likely to perceive continued alcohol consumption as harmful to their fatigue and overall survival, when compared to non-palliative patients, especially after receiving counselling. Given the lack of data on the benefits or harm of mild-moderate alcohol use and a strong emphasis on quality of life, future research should focus on effects of alcohol in palliative patients, and there should be improved education to both providers and patients on regarding the current lack of information.