bluuebunny/crossref_metadata_2025_split huggingface dataset:
Low molecular weight heparin (LMWH) usage for cancer patients under palliative care.
Authors: Ali Ahmed , Zayir Amani , Hamody Adel , Ahmed Shakeel 
Published: November 2017

1 Background: Cancer patients are at increased risk of thromboembolic complications. Studies show that prophylactic low molecular weight heparin (LMWH) can successfully reduce incidence of venous thromboembolic events; however, a survival benefit for patients with advanced cancer who receive LMWH in a palliative setting has not been confirmed. Methods: We evaluated the survival of cancer patients undergoing palliative treatment in a tertiary care hospital in Saudi Arabia during 2016. Patients were followed from the day of palliative care initiation until the day of death, and we compared the survival of patients who received LMWH (enoxaparin) with those who did not. Gender, diagnosis (site of cancer), and date of diagnosis were considered for subgroup analysis. Results: Of the 209 patients included in this study, enoxaparin was administered to 91(about 44%), while 117 (about 56%) did not receive any LMWH, and the treatment of one patient was not clearly defined. Male and female patients are equally distributed (104 and 105 patients, respectively). Cancer sites included breast, brain, gastrointestinal, genitourinary, lung, hematological malignancies, bone, and others. Although there was generally no statistical difference in survival time between treated and untreated groups (approximately 48 days each), subgroup analyses showed a statistically significant but not clinically significant survival benefit for patients with genitourinary cancers, such as uterine, urinary bladder, ovarian, or prostatic carcinomas who received LMWH (14.15 to 63.85 Days, P=0.0046). Conclusions: Prophylactic treatment with LMWH provided no clinically significant survival benefit to terminally ill cancer patients when administered in conjunction with other medications. Further prospective trials are warranted. Clinical trial information: ONC0329.
Advance care planning in Hispanic/Latino and non-Hispanic white patients with cancer.
Authors: Friedman X , Cardenas Veronica , Nelson Sandahl , Gabbai-Saldate Paulette , Ma Joseph , Cohen-Arazi Yael , Martinez Maria Elena , Ng Katrina , Roeland Eric 
Published: November 2017

10 Background: Advance care planning (ACP) is a process whereby patients communicate their end-of-life treatment preferences. Despite a growing US Hispanic/Latino population, much remains unknown regarding ACP for Hispanic/Latinos. This study examined the association between ethnicity and ACP, including individual surrogate markers—code status documentation, advance directive (AD)/physician order for life-sustaining treatment (POLST) completion, and/or palliative care (PC) consultation—in deceased Hispanic/Latino vs white non-Hispanic (WNH) cancer patients. Methods: A retrospective analysis was performed in randomly-selected, matched pairs of deceased (2011-2016) Hispanic/Latino and WNH cancer patients at an NCI-designated cancer center. Pairs were matched based on sex, age (at diagnosis/death), and cancer type. Conditional logistic regression was used to assess ethnicity (Hispanic/Latino vs WNH) and the presence any ACP (yes/no). Secondary aims examined the association between ethnicity and the presence of individual ACP surrogate markers using separate logistic regression models. All analyses were completed using SAS 9.4. Results: 152 eligible matched pairs were analyzed with no significant differences in presence of any ACP, code status documentation, or PC consultation. Cancer patients with AD/POLST completion were 58% less likely to be Hispanic/Latino than WNH. Conclusions: Historically, ACP in cancer care is difficult to implement with 20-30% penetrance across all racial/ethnic groups. This study suggests even lower rates of AD/POLST completion in Hispanic/Latino patients consistent with prior studies. However, based on the small sample size, these results are not generalizable and requires further evaluation. This study affirms the need for continued efforts to improve AD/POLST completion in Hispanic/Latinos. [Table: see text]
Impact of socioeconomic status on pretreatment cachexia and survival in non-small cell lung cancer.
Authors: Lau Steven , Gannavarapu Bhavani S , Carter Kristen , Gao Ang , Ahn Chul , Meyer Jeffrey John , Sher David J , Jatoi Aminah , Iyengar Puneeth 
Published: November 2017

101 Background: Socioeconomic status (SES) influences healthcare outcomes, but the influence of SES on cancer cachexia is unknown. We identify components of SES associated with pre-treatment cachexia in patients with non-small cell lung cancer (NSCLC) and assess their prognostic significance on survival. Methods: A prospectively maintained institutional tumor registry identified 1,365 patients with NSCLC consecutively treated at a tertiary care health system from 1/1/06 to 12/31/13. Insurance status was abstracted from the registry. Educational attainment and household income were estimated from census data using location of primary residence. Cancer cachexia was defined retrospectively using the international consensus definition. Multivariable regression analysis was used to identify prognostic factors of pre-treatment cancer cachexia and survival. Results: Cachexia was present at the time of NSCLC diagnosis in 30% of all patients including 17% of patients with stage I disease. Patients with Medicaid or no insurance were more likely to have pre-treatment cachexia compared to those with private insurance (Odds Ratio [OR] 1.9, 95% Confidence Interval [CI] 1.2-3.1; OR 2.1, 95% CI 1.2-3.4, respectively). Attainment of a high school diploma was inversely associated with pre-treatment cachexia (OR: 0.1, 95% CI 0.02-0.2). On multivariable analysis, comorbidity, histology, tumor grade, and disease stage were prognostic of survival among cachectic patients; however, insurance status, educational attainment, and household income were not. Conclusions: Lower SES is associated with pre-treatment cachexia in patients with NSCLC, but pre-treatment cachexia is detrimental to survival regardless of SES. Together, these findings suggest early intervention for patients with cancer cachexia may improve outcomes.
Palliative care in a community-based oncology private practice.
Authors: Friedman Loren L. , Cronin Paul , Siddiqui Muhammad M. , Garcia Marie A. , Anderson Linda C. 
Published: November 2017

107 Background: Integration of palliative care in the outpatient oncology clinic improves the quality of care for patients with advanced cancer. While models of outpatient palliative care (PC) in the academic oncology clinic have been demonstrated, the feasibility of PC in a private practice oncology clinic has not been established. Methods: In 2014 our 8 office oncology practice composed of 30 physicians and 10 advanced practice providers hired a full-time PC physician. Our questions included: 1) Would the PC physician be valued by the oncologists in the practice; 2) Would internal referrals and follow-up encounters provide sufficient activity for PC physician employment; 3) Would the revenue received for patient encounters offset the cost to the practice of the PC physicians? We emailed a survey to providers; we tallied data on patient encounters; and we reviewed the actual dollar amount of reimbursements received from payers for PC evaluation and management codes for a 1 year period. Results: In our second full year, a single palliative care physician saw 487 initial consultations and 1273 follow-up encounters for a total of 1760 encounters. The collected revenue for these encounters covered 102% of the palliative care physician’s combined salary and overhead. This data enabled the additional hiring of a second PC physician in 2016. Of 36 providers surveyed, 24 (67%) completed our 10 question survey. On a 1-5 point scale, when asked to rank the positive influence of the palliative care program on the culture of patient care in the practice, the aggregate score was 4.96. When asked questions on how helpful the palliative care program was to the providers in managing a variety of patient concerns, all items scored between 4.5 and 5. A question on how helpful the PC physicians were as a curbside resource received an aggregate score of 5.0. Conclusions: Based on referral numbers and surveyed attitudes, PC physicians were readily accepted into the fabric of a community based oncology practice. Analysis of financial data demonstrates that the PC physician can cover a substantial part of their salary requirement through billing for patient encounters.
Palliative care utilization in oncology patients with 30-day hospital readmission.
Authors: Pandya Chintan , Nielsen Gradon , Hu John , Ram Jodi , Rozario Cheryl , Wallace Danielle , Hamel Lauren M. , Dougherty David W. 
Published: November 2017

110 Background: Reducing the rate of hospital readmissions is an important aspect of improving quality of life and cost of care for patients with advanced cancer. Early Palliative Care (PC) has been shown to improve quality of life and downstream healthcare utilization in patients with advanced cancer. The aim of this study was to examine palliative care (PC) utilization and factors associated with 30-day readmission in cancer patients. Methods: All patients with 30 day readmissions to the inpatient oncology service at the Wilmot Cancer Institute from July 2015-June 2016 were identified. Chart reviews were conducted to determine primary cancer stage and type; reason for, length of stay and discharge disposition (e.g. discharged on hospice, deceased) for index and readmission; potential preventability of readmission; and if and when the patient had met with PC. Results: A total of thirty-nine patients experienced a 30-day readmission, with 95% of patients having stage IV disease and 77% having a primary lung or GI malignancy. Most patients (74%) had not met with PC at the time of the index admission and 49% of patients had not met with PC by the time of readmission. Forty one percent (N = 17) of patients either died during readmission or were discharged on hospice. Forty one percent (N = 7) of those that died during readmission or were discharged on hospice did not meet with palliative care. Forty four percent of readmissions were classified as potentially preventable. Conclusions: Nearly half of all advanced cancer patients had not met with PC by the time of their readmission. Upon readmission, many patients were either discharged to hospice or died, suggesting that patients with advanced cancer could benefit from earlier PC. Increased and improved patient-oncologist PC communication, including referrals to PC specialists, may reduce readmission rates for patients with advanced cancer.
Utilization of support services, emergency department, and hospital in advanced cancer patients with severe disease in a community cancer institute.
Authors: McNaughton Caitlyn , Gehron Emily , Sivendran Shanthi , Holliday Rachel , Horst Michael , Newport Kristina Braine 
Published: November 2017

112 Background: Patients with advanced cancer are at high risk for emergency department (ED) and hospital utilization, which is distressing and costly. Palliative care consultation and symptom management clinics have been shown to decrease ED and hospital utilization, but the frequency and composition of these interventions is still being delineated. More evaluation is needed to determine practical approaches to implementing interdisciplinary management of distress for patients with advanced cancer in the community setting. This retrospective review evaluates healthcare utilization with respect to support services provided in our community based cancer institute. Methods: 157 patients with advanced cancer of lung, gastrointestinal, genitourinary or gynecologic origin diagnosed January 2015-December 2015 were reviewed retrospectively. Descriptive data including demographics, disease characteristics, palliative care consultation, support services utilized and ED visits/hospitalizations were collected for 12 months, or to date of death. Support services included physician assistant–led symptom management, nurse navigator, social worker, nutrition, financial counselor, chaplain, and oncology clinical counselor. Support service referrals were made based on identified needs. Severe disease was defined as death within 6 months of diagnosis. Results: Patients with severe disease had a mean of 6 ED visits per year, significantly greater than patients with non-severe disease (p < 0.001). Patients with severe disease also had more contacts with support services per year (30.3 vs 9.1, p < 0.001). A palliative care consult was placed in 50% of patients with severe disease, and 23% in patients with non-severe disease (p < 0.001). Conclusions: Patients with advanced cancer have evidence of significant needs as reflected by high healthcare utilization in the last 6 months of life. As needed involvement of support services correlated with severity of disease but did not result in decreased ED utilization or hospitalization. This suggests that availability of support services alone is not a feasible strategy to impact unplanned hospitalizations and ED visits.
A retrospective review of patients with hematological malignancy referred to an inpatient palliative care service in a tertiary hospital.
Authors: Meng Yee Choon , Koh Mervyn Yong Hwang , Chiam Zi Yan , Zhang Jun Jun , Hum Yin Mei, Allyn 
Published: November 2017

117 Background: Patients with hematological malignancies are referred to palliative care service later and less often than patients with solid organ tumor. However, there are no data in Singapore, on the referral pattern among patients with hematological malignancy. The objective of the study is to identify the characteristics and outcomes of patients with hematological malignancy referred to an In-patient Palliative Care Service (PCS). Methods: We performed a retrospective review of all patients with hematological malignancies referred to the in-patient PCS from December 2015 to December 2016. Basic demographics and outcomes of patients’ admission were collected as per protocol. Results: 53 patients were included in the study. 27 (50.9%) patients were male, 49 (92.5%) were ≥60 years old, 20 (37.7%) were receiving cancer treatment at the point of referral, and 24 (45.3%) had Palliative Performance Scale (PPS) ≤ 40%. The most common hematological diagnosis was lymphoma (N = 26, 49.1%). The top 3 reasons for referral were symptom management (N = 44; 83%), advance disease (N = 24; 45.3% and end-of-life discussion (N = 15, 28.3%). Among 44 patients referred for symptom control, 18 (40.9%) had pain, 12 (27.3%) had dyspnoea, 8 (18.2%) had confusion and 6 (13.6%) had fatigue or drowsiness. 30 patients (56.6%) died during the admission. Among 30 patients who died, the mean time from referral to death was 9.8 days; 16 (53.3%) died within 1 week from referral, 9 (30%) died between 1-4 weeks from referral and 5 (16.7%) died beyond 4 weeks after referral.5 patients (9.4%) had Advance Care Planning completed. Conclusions: Our review showed that patients with hematological malignancies are referred late in their disease trajectory and have high Palliative Care needs. Hence, collaborative effort to facilitate timely referral of patients with hematological malignancy to PCS will optimize end-of-life care.
Urgent versus elective inpatient anticancer therapy in patients with metastatic solid tumors: Analysis of admission characteristics and posthospitalization clinical outcomes.
Authors: McPherson Jordan P. , Namanny Halee R. , Brant Jamie L. , Patterson Paige A. , Howell Julie A. , Loveday Brighton A. , Montague Rachel M. , Piper-Williams Jaclyn J. , Shaw Jennifer S. , Sindt Jill E. , Thielking Paul D. , Biskupiak Joseph E. , Beck Anna Catherine , Stenehjem David D. ,   HCI Palliative Care Working Group
Published: November 2017

12 Background: Palliative chemotherapy is used urgently in the hospital due to rapid disease progression, risk of toxicity, or other cancer-related acute medical diagnoses. Our primary objective was to characterize the utilization of urgent anticancer therapy (antiCT) in metastatic solid tumor patients. Secondary objectives were to compare time to next treatment (TTNT) and overall survival (OS) between those who received antiCT during urgent and elective admissions, and to further characterize if goals of care (GOC) or prognosis discussions were included in the decision process. Methods: This was a single-center observational cohort study of patients with advanced solid tumors treated with antiCT during urgent versus elective inpatient admissions at Huntsman Cancer Institute from June 1, 2014 to June 30, 2016. Line of therapy, ICU utilization, readmission rate, palliative care (PC) consultation, and documentation of GOC and prognosis discussions were evaluated for patients who received urgent antiCT. Results: 265 patients were included. The majority were treated during urgent admissions (63.7%). Patients receiving urgent antiCT were older (57.6 ± 14.2 vs 54.9 ± 14.9 years, p < 0.001) with more advanced cancer at diagnosis (56.8% vs 37.5%, p = 0.009). Urgent antiCT was associated with both decreased median TTNT (3.5 vs 15.7 months; p < 0.001) and median OS (4.7 vs 31.4 months; p < 0.001) as compared to elective antiCT. Of those who received urgent antiCT, 47.9% were started on a new antiCT during admission. First-line therapy accounted for 58% of urgent antiCT, and 27.2% was third-line or higher. ICU care was utilized for 20.7% of these patients, and 23.1% were readmitted ≤30 days after discharge. PC was consulted for 37.9% during admission. Less than half (41.4%) had a documented GOC discussion; only 32.5% had a documented prognosis discussion. Conclusions: Urgent inpatient antiCT is associated with suboptimal advance care planning despite high risk of mortality in the 5 months following admission. Efforts to identify predictors of early mortality after urgent antiCT and incorporate earlier GOC and prognosis discussions are warranted.
Phase III safety evaluation of intravenous NEPA, a novel fixed antiemetic combination of fosnetupitant and palonosetron, over multiple cycles.
Authors: Schwartzberg Lee Steven , Andric Zoran Gojko , Kowalski Dariusz , Voisin Daniel , Rizzi Giada , Karthaus Meinolf 
Published: November 2017

122 Background: NEPA is an oral fixed combination of the selective NK1 receptor antagonist (RA), netupitant (300 mg), and pharmacologically distinct 5-HT3RA, palonosetron (PALO 0.50 mg), combining two guideline-recommended antiemetic classes in a convenient single capsule. Oral NEPA has shown superior prevention of chemotherapy-induced nausea and vomiting (CINV) over oral PALO, sustained efficacy over multiple cycles, and well-established safety in >1500 patients (pts). To offer additional convenience for health care practitioners and pts, an intravenous (IV) formulation of the NEPA fixed combination (fosnetupitant 235 mg/PALO 0.25 mg) was developed. Methods: This randomized, multinational, double-blind, stratified (by gender/country) phase 3 study in chemotherapy-naïve pts with solid tumors was designed to assess the safety of a single 30-minute infusion of IV NEPA prior to initial/up to 4 repeated cycles of highly emetogenic chemotherapy (HEC). Patients received either IV NEPA or oral NEPA, both with oral dexamethasone on days 1-4. Safety was assessed by treatment-emergent adverse events (TEAEs), laboratory tests, vital signs and ECGs. Results: 404 pts were evaluated for a total of 1312 exposures. Overall, 53% of pts were male with a mean age of 60 years; 99% of pts were white and cisplatin-containing regimen was the HEC for 96% of pts; lung cancer was the most common tumor (55% pts). The AE profiles were similar for both groups in cycle 1 and across all cycles (See Table), with no increased incidence of AEs in subsequent cycles. No infusion site reactions related to IV NEPA occurred. No clinically relevant changes in QTcor cardiac safety concerns were observed. Conclusions: IV NEPA is safe and well-tolerated over multiple cycles with a similar safety profile to oral NEPA in pts receiving HEC. Clinical trial information: NCT02517021. [Table: see text]
The utilization and impact of oncology supportive care clinics on patients with metastatic lung cancer.
Authors: Kim Yan S , Luo Esther J , Chin Matthew T , Leong Shelley , Rajan Sudhir S , Escobar Gabriel J 
Published: November 2017

123 Background: The American Society of Clinical Oncology has endorsed early integration of oncology with palliative care. In 2012, Kaiser Permanente Northern California (KPNC) introduced Oncology Supportive Care Clinics (OSCCs). OSCCs are outpatient palliative care clinics designed to incorporate palliative care into standard oncology practice at the time of a patient's cancer diagnosis. This study examines the utilization and impact of OSCCs on patients with metastatic lung cancer. Methods: We identified adult patients with incidental stage IV lung cancer using the KPNC cancer registry from 2012-2015 and followed them for 12 months. We ascertained OSCC utilization using KPNC’s electronic health record. We examined the patterns of OSCC referral/utilization and compared survival, in-hospital death, and treatment received in patients who used and did not use OSCC services. Results: A total of 607 patients were included and 245 (40.4%) were referred to OSCC. The median time from diagnosis to referral was 48 days and ¼ were referred within 15 days. The majority (86%) of the patients referred were seen by OSCC. Only 22 patients (9.0%) refused to be seen. We found no large patient- or facility-level differences between patients referred and not referred to OSCC. At the end of follow up, 398 (65.6%) of the patients died. Patients seen by OSCC were less likely to die (59.2% vs. 68.9%, p < 0.02) at 1 year. Fewer patients who used OSCC died in the hospital compared to those who did not (26 or 12.3% vs. 67 or 16.9%); however, it did not achieve statistical significance (p = 0.13). Among patients who used OSCC, 166 (78.7%) received anti-cancer treatment, compared to 221 (55.8%) among those who did not (p < 0.001). Conclusions: Despite having a robust infrastructure and integrated system in place, over half of the patients diagnosed with metastatic lung cancer did not receive a referral. Future work is needed to understand the reasons why so many patients were not referred. Furthermore, our data showed that receiving OSCC services did not adversely impact survival and the receipt of anti-cancer treatment. These findings serve to reassure patients and providers that the addition of palliative care does not harm patients or limit their treatment.