bluuebunny/crossref_metadata_2025_split huggingface dataset:
Exploring the relationship of self-reported lack of appetite to patient characteristics and symptom burden.
Authors: Hyland Kelly , Fenech Alyssa L , Portman Diane , Donovan Kristine A. 
Published: November 2017

187 Background: Cancer anorexia-cachexia syndrome (CACS) in patients is associated with decreases in lean body mass and body weight. Self-reported lack of appetite may be an important indicator for early identification of CACS. The current analyses examined the relationship of perceived lack of appetite to patient characteristics and overall symptom burden in a large mixed cancer sample referred to a palliative care clinic. Methods: We conducted a retrospective review of patients newly referred to an outpatient palliative care clinic over a two-year period. Data on demographic and clinical characteristics and patient-reported symptom scores on the Edmonton Symptom Assessment Scale (ESAS) were abstracted. Pearson’s correlations and ANOVAs were used to assess relationships between variables. Multiple regression analysis was used to evaluate the relative contribution of variables that were significantly correlated with lack of appetite at the univariate level. Results: Data on 544 patients ( M=53.7 years) showed that older age (r=12, p<.01), not being married or in a marriage-like relationship (r=.09, p=.04), having insurance other than managed care insurance (r=.10, p=.02), lower body mass index (BMI; r=.11, p<.01), marijuana use (r=.18, p<.0001), and overall symptom burden (ESAS total score r=.52, p < .0001) were associated with worse lack of appetite ( M=3.5, SD=3.1). Patients who were underweight (BMI <18.5, 46.7%) reported significantly worse lack of appetite than patients who were normal weight, overweight, or obese ( M=3.9, SD=3.2, p<.01). The final hierarchical regression model accounted for 34% of the variance in lack of appetite, with age, marital status, BMI, marijuana use, and total symptom burden remaining significant independent correlates (p’ s <.01). Conclusions: Contrary to expectations, relatively few clinical correlates were associated with self-reported lack of appetite. Future research should explore inter-individual genetic factors to explain alterations in lean body mass and body weight that may contribute to poor appetite in patients. Such factors may be important indicators for early identification of CACS.
Meditation as a doula-delivered intervention for underserved late-stage cancer patients: A feasibility trial.
Authors: Moadel Alyson B. , Camacho Fernando J. , Schlecht Nicolas 
Published: November 2017

188 Background: Socioeconomic disparities in psychosocial outcomes among cancer patients have been documented. High interest in peer support and mind-body therapies across diverse populations presents an opportunity for enhancing end-of-life care in the underserved setting. We present the results of a psychosocial needs assessment, and the findings from a feasibility trial in which peer navigators (PN; cancer survivor volunteers) were taught to deliver Loving Kindness (LK) Meditation in preparation for their role as end-of-life “Doulas”. Methods: (1) A survey of psychosocial symptoms and needs was administered to a convenience sample of 56 stage IV patients from an NCI-designated cancer center in Bronx, NY. Patients were female (75%), African American (43%), Hispanic (45%), and 56 M years old. (2) A feasibility trial randomly assigned 9 patients to receive LK meditation delivered by 1 of 4 trained PNs or a professional meditation instructor. The trial was rated on 8 measures of feasibility as set forth by Bowen et al 2009. Results: Patients reported high sadness (66%), anxiety (54%), anger (41%), and spiritual distress (18%) with 70% endorsing an interest in mind-body therapies “such as meditation”, and 46% an interest in a PN. In the LK meditation feasibility trial, patients reported improved positive affect scores by a clinically significant margin of 13%, with equivalent impact and satisfaction for PN relative to professional instructor. Conclusions: Inner city late stage cancer patients endorse high distress, and high interest in peer support and mind-body interventions. Feasibility testing demonstrates that LK meditation is responsive to patient preference and demonstrates preliminary efficaciousness. Findings suggest that Doula-delivered meditation for underserved patients presents a unique resource in the palliative care setting.
Is stereotactic radiosurgery of brain metastases in patients with poor performance status worthwhile?
Authors: Ampil Federico , Kim Donghyun , Richards Troy , Vora Moiz , Mills Glenn Morris , Nanda Anil 
Published: November 2017

192 Background: Performance status is a consistent predictor of outcome in people with advanced disease. Variable prognosis has not led to the exclusion of patients with Karnofsky performance scores of < 70 from treatment of brain metastases (BRM) with stereotactic radiosurgery (SRS). The role of SRS for BRM in individuals with poor performance status (PPS) has not been elucidated to date. To better understand the prognostic utility of SRS in this particular patient cohort, we assessed the longevity periods of our treated PPS subjects with BRM. Methods: A retrospective review of patients with BRM treated by SRS during a 10-year period (2000-2009) identified 22 adult individuals with PPS; PPS was defined by the presence of severe hemiparesis or cerebellar ataxia. The primary endpoint of the analysis was survival because of some limitations in the obtained data. The mean follow-up was 26 months (range: < 1 to 144 months). Results: The mean age was 55.8 years, and the majority of the subjects were female. Most of the patients were younger and diagnosed with solitary brain metastasis. The synchronous primary malignant tumor was not yet under control in a third of the patients, and extracranial metastases were noted in 45% of the subjects. Thirteen people (59%) died within two months after therapy, and nine patients (41%) lived for two years or longer. The overall crude survival rates at 1 year and 5 years were 41% and 18%, respectively. Treatment response information was not available in the short-survival group because of early demise. Intracranial tumor control was achieved in the long-term survivors, considering that BRM progression requiring repeat SRS was not observed in any instance. Characterization of the two groups with different longevities was not possible. Conclusions: Early mortality was not predominant in this limited experience, and the observed prolonged survival suggests that SRS still represents a valuable treatment option for individuals with PPS and BRM.
Opioid utilization patterns among patients with cancer and noncancer pain.
Authors: Datto Catherine J. , Hu Yiqun , Wittbrodt Eric , Fine Perry G. 
Published: November 2017

194 Background: Opioids are used to manage moderate to severe pain in patients with cancer and non-cancer pain. Limited data exist comparing opioid utilization patterns between these two patient populations. Methods: This retrospective, commercial administrative claims database analysis (HealthCore Integrated Research Environment) investigated opioid use patterns, including opioid dose escalation, in adult patients with cancer-related (CP) and non-cancer-related pain (NCP). Adults (age ≥18 years) with at least one pharmacy claim for an opioid between July 1, 2006, and September 30, 2014, were identified (index date). Patients selected for analysis had to have continuous plan eligibility for 6 months pre- and 12 months post-index date and opioid use for at least 4 weeks. Patients with opioid use related to cancer pain were identified by a medical claim for a cancer diagnosis coded within 30 days prior to the index opioid date. Results: A total of 9,209 patients with CP and 409,703 patients with NCP were analyzed. Patients with CP were older than patients with NCP (mean [SD]: 62.6 [12.9] yrs vs. 49.3 [15.3] yrs); other demographics were similar between cohorts. The most common cancer diagnoses were breast, lung, and prostate. Hydrocodone was the most common opioid prescribed for both cohorts. Total mean (SD) days of opioid therapy were 167.1 (341.8) for CP and 196.6 (421.1) for NCP, with similar rates of opioid use for ≥1 year (10.6% for CP; 13.6% for NCP). Median index opioid doses were consistent between the cohorts (CP: 51.7 morphine-equivalent units (MEU); NCP: 45.0 MEU). Median post-index (after the first 30 days) opioid doses were also similar (CP: 55.8 MEU; NCP: 45.3 MEU). Post-index opioid dose reductions occurred in approximately one-third of both cohorts. Opioid dose escalations (up to dose doubling) occurred in 31.8% of CP and 28.3% of NCP patients. More patients died during the follow-up period in the CP cohort (24.1%) compared with the NCP cohort (0.02%). Conclusions: The use of opioids bears many similarities between patients with cancer pain and non-cancer pain, including clinically similar rates of chronic opioid utilization and dose escalation. This study was supported by AstraZeneca.
Risk of suicide in persons with gastrointestinal cancer: A population-based study.
Authors: Deng Aileen , Basu Mallick Atrayee 
Published: November 2017

197 Background: Patients with cancer have nearly twice the incidence of suicide compared to the general population(1). To date, identifying patients at risk for suicide remains challenging. The purpose of this study was to identify risk factors of suicide among patients with GI cancer. Methods: A retrospective analysis was completed using Surveillance, Epidemiology, and End Results data from 1973 to 2014. Comparisons with the general US population were based on US mortality data collected by the National Center for Health Statistics. Suicide incidence, rates and standardized mortality ratio (SMR) were obtained by SEER*Stat 8.3.4. Results: Among 711859 patients with GI cancer observed for 3373014 person-years, 1116 suicides were identified, for an adjusted suicide rate of 33.1/100,000 person-years (SMR 1.74 [95% CI 1.64-1.85]). The highest suicide risks (SR) were in esophageal (SMR 5.42 [95% CI 4.30-6.75]), pancreatic (SMR 4.91 [95% CI 3.83-6.19]) and liver or intrahepatic biliary cancer (SMR 3.36 [95% CI 2.35-4.65]). Higher SRs were associated with unmarried status, age 40 years and older at diagnosis and the first 5 years after diagnosis. In esophageal (EC) and pancreatic (PC) cancer, SR was 8 folds higher in unmarried patients compared to the general population with a SMR of 8.31 [95% CI 5.68-11.73] and 7.68 [95% CI 5.18-10.97], respectively. In EC and PC, SR was highest in patients > 80 years (SMR 7.09 [95% CI 3.40-13.03]) and 40-59 years at diagnosis (SMR 7.10 [95% CI 1.93-18.18]), respectively. Patients have especially high SR the first year after diagnosis in EC (SMR 10.25 [95% CI 7.65-13.44]) and PC (SMR 7.72 [95% CI 5.83-10.03]). Conclusions: While overall, patients with GI cancer have nearly twice the SR, those with certain cancer subtypes have up to 5 times the SR when compared to the general population. SRs are highest in esophageal, pancreatic and liver or intrahepatic biliary cancer. Suicide screening should especially target patients with EC and PC who are unmarried or lack a support system and within the first year after cancer diagnosis.
A systematic review and meta-analysis of randomized controlled trials to evaluate the risk of fatigue and pain among patients treated with ibrutinib.
Authors: Zaw Myo , Thein Kyaw Zin , Han Myat M. , D’Cunha Ruth , Kaleem Hassan , Hardwicke Fred L. , Tijani Lukman 
Published: November 2017

213 Background: Bruton’s tyrosine kinase (BTK), a kinase downstream of the B-cell receptor, involves in the B cell survival and proliferation and has become an attractive therapeutic target. Ibrutinib is an oral potent, covalent inhibitor of BTK and hence employed in many hematologic malignancies. We performed a systematic review and pooled analysis of randomized controlled trials (RCTs) to determine the risk of fatigue and pain among patients treated with ibrutinib. Methods: We performed a comprehensive literature search using MEDLINE, EMBASE databases and meeting abstracts through December 31, 2016. RCTs that mention fatigue, arthralgia, muscle spasm, back pain, pain in extremity and myalgia as adverse effects were incorporated in the analysis. Mantel-Haenszel method was used to calculate the estimated pooled risk ratio with 95% confidence interval (CI). Results: Four phase 3 RCTs with a total of 1505 patients were eligible for the analysis. Studies compared Ibrutinib (I) vs ofatumumab, I vs chlorambucil, I+ bendamustine (B)+ rituximab (R) vs placebo + B+ R and I vs temsirolimus were included in the analysis. The relative risks (RR) of all-grade side effects were as follows: fatigue, 0.87 (95% CI: 0.74- 1.03, p = 0.11); arthralgia, 1.97 (95% CI: 1.11- 3.50, p = 0.02); muscle spasm, 1.92 (95% CI: 1.22- 3.02, p = 0.005); back pain, 1.56 (95% CI: 1.02- 2.37, p = 0.03); pain in extremity, 2.47 (95% CI: 1.14- 5.36, p = 0.02); and myalgia, 2.68 (95% CI: 1.18- 6.05, p = 0.01). The RR of high-grade side effects were as follows: fatigue, 0.70 (95% CI: 0.37- 1.33, p = 0.28); arthralgia, 3.62 (95% CI: 0.74- 17.66, p = 0.11); back pain, 2.80 (95% CI: 0.42- 18.35, p = 0.28); pain in extremity, 2.96 (95% CI: 0.31- 28.4, p = 0.34); and myalgia, 2.96 (95% CI: 0.31- 28.44, p = 0.34). Conclusions: Our meta-analysis demonstrated that the risk of all-grade arthralgia, muscle spasm, back pain, pain in extremity and myalgia with ibrutinib was high. Pain is a major determinant of quality of life in cancer patients undergoing chemotherapy and recognizing these may help clinicians in delivering proper supportive care.
Trismus and reduced quality of life in patients with oral squamous cell carcinoma who received postoperative radiotherapy alone or combined with chemotherapy.
Authors: Nicolatou-Galitis Ourania , Psyrri Amanda 
Published: November 2017

222 Background: Patients, who receive radiotherapy (RT) for head and neck cancer, develop chronic functional abnormalities and reduced mouth opening-trismus, surviving with reduced quality of life (QoL). We aimed to study trismus and QoL in patients with oral cancer, who received post-operative radiotherapy or chemoradiotherapy. Methods: Patients, who receive radiotherapy (RT) for head and neck cancer, develop chronic functional abnormalities and reduced mouth opening-trismus, surviving with reduced quality of life (QoL). We aimed to study trismus and QoL in patients with oral cancer, who received post-operative radiotherapy or chemoradiotherapy. Results: Mean RT dose was 64.3 Gray. Six patients received chemoradiotherapy. Severe mucositis, pain and xerostomia were recorded in 6 and 5 patients respectively. MMO was reduced in all patients. The mean MMO (34 mm) reached the level of trismus. The total number of symptoms increased from 3.1 to 6.3 in C-30 and from 3.1 to 8.8 per patient in the H/N35. Severe fatigue, pain, limitations at work, weakness, sad feelings, family problems, sleeping problems, anorexia, financial difficulties, tense/irritable, constipation, nausea, vomiting and depression were most often reported with C-30. Most patients reported poor to moderate quality of life. Severe oral, jaw and neck pain, swallowing problems, taste alterations, sticky saliva, dry mouth, coarseness, dental problems, feeling sick and reduced interest in life/sex were the most common symptoms reported with N/H35. Conclusions: The observed trismus, the 2- to 3-fold increase of symptoms and poorer quality of life highlighted the need for support of oral cancer patients, who receive postoperative radiotherapy or chemoradiotherapy. Reduced systemic health, financial difficulties and family problems could be some of the main reasons for the inadequate compliance of our patients to the study, as shown by others, too. The strength of our study was the homogeneous group of patients: all had oral squamous cell carcinoma and all received post-operative radiotherapy or chemoradiotherapy. The small number of patients represents a weakness.
Frequency and factors predicting the risk for aberrant opioid use in patients receiving outpatient palliative care at a comprehensive cancer center.
Authors: Yennu Sriram , Edwards Tonya , Arthur Joseph Anthony , Lu Zhanni , Najera John M , Nguyen Kristy , Rodriguez Eden Mae , Joy Manju P , Kuriakose Leela , Wu Jimin , Liu Diane D , Williams Janet L. , Reddy Suresh , Bruera Eduardo 
Published: November 2017

228 Background: Opioid misuse is a growing crisis among patients with chronic pain. Cancer patients at risk of aberrant drug behaviors (ADB) are frequently underdiagnosed in routine cancer care. The aim of this study was to determine the frequency and factors predicting risk for Aberrant Opioid and Drug use among Patients receiving Outpatient Supportive Care Consultation at a Comprehensive Cancer Center Methods: In this retrospective study, 690 consecutive patients referred to a supportive care clinic were reviewed. Patients were eligible if they were ≥18 years, had a diagnosis of cancer, and were on opioids for pain for atleast a week. All patients were assessed with the Edmonton Symptom Assessment Scale (ESAS), SOAPP-14, and CAGE-AID. At risk patients with aberrant opioid behavior (+Risk) was defined as SOAPP-14 score ≥7. Descriptive statistics, spearman correlation coefficient, multivariate analysis were performed. Results: 690/752 consults were eligible. A total of 135(20%)were +risk. 69(11%) were CAGE-AID +.SOAPP-14 scores were positively associated with CAGE-AID p < 0.001; male gender p = 0.007; ESAS pain p = < 0.006; ESAS depression p < 0.001; ESAS anxiety, p < 0.001, and ESAS financial distress p = < 0.001. Multivariate analysis indicated that the odds ratio for +Risk was 2.47 in patients with CAGE-AID+ (p < 0.001), 1.95 for male gender (p = 0.005), 1.11 per point for ESAS anxiety (p = 0.019), and 1.1 per point. for ESAS financial distress (p = 0.02). Conclusions: 20% of cancer patients on opioids presenting to supportive care center are at risk of aberrant drug behavior. Male patients with anxiety, financial distress, and prior alcoholism/illicit drug use are significant predictors of +Risk. Further research to effectively manage these patients is needed.
Effect of palliative surgery, chemotherapy, and radiation in stage IV pancreatic cancer.
Authors: Vuong Brooke , Dehal Ahmed , Graff-Baker Amanda , Chang Shu-Ching , Foshag Leland Jay , Bilchik Anton , Goldfarb Melanie 
Published: November 2017

233 Background: Despite significant advances in multi-modality treatment for pancreatic adenocarcinoma (PC), prognosis for stage IV PC remains poor. While reducing suffering and optimizing quality of life are the primary goals of palliative therapies, these interventions may extend overall survival. We examined the impact on survival when aggressive palliative treatments including surgery, chemotherapy, or radiation were employed in end-of-life care. Methods: The 2004-2014 National Cancer Data Base (NCDB) was queried to identify patients with stage IV PC that did not undergo primary surgical resection. Univariate (Kaplan Meier and log-rank) and multivariable (Cox proportional hazard) analyses were used to assess the associations between patient characteristics, use of palliative therapies, and overall survival. Results: Of 72,736 patients identified with metastatic stage IV PC, 2,097 (3%) underwent surgical palliation (ST), 5,615 (8%) received palliative chemotherapy (CT), 940 (1%) received palliative radiation (RT), 1,163 (2%) received multimodality treatment (MMT), and 62,921 (87%) had no aggressive palliative intervention (NT). The choice of palliative therapy, if any, was influenced by all demographic and tumor variables except for gender (all p < 0.001). Median OS was greatest after CT (5.09 months, p < 0.001) compared to any other modality (NT: 3.45months, ST: 3.71months, RT: 3.25months, MMT: 4.47months). This remained true regardless of age, gender, race/ethnicity, insurance, and facility type. After adjusting for all demographic and tumor factors, use of CT decreased the annual risk of death by 20% (HR = 0.8; 95%CI [0.77, 0.82]) and MMT by 10% (HR = 0.9; 95%CI [0.84, 0.96]). Employment of RT increased risk of death by 9% (HR = 1.09; 95%CI [1.01, 1.17]) and ST did not affect OS (HR = 1.01; 95%CI [0.96,1.06]). Conclusions: Despite advances in palliative treatments, Stage IV PC arries a dismal prognosis. Palliative RT may shorten survival. Equivalent survival for ST versus NT suggests that this may be beneficial in the appropriate patient. Palliative CT independently improved survival by approximately 6 weeks and should be considered in patients that want to extend survival and can tolerate the toxicity.
Health providers’ perspectives on medical marijuana use.
Authors: Martins-Welch Diana , Nouryan Christian , Kline Myriam , Modayil Sony 
Published: November 2017

235 Background: According to the CDC, 117 million Americans have one or more chronic health conditions and 31% have used two or more prescription drugs in the past month. Approximately 40% of adults in the United States are using some form of Complementary and Alternative Medicine. Medical marijuana is one such medicine, and to date 29 states have legalized medical marijuana. Methods: A multicenter, anonymous, on-line survey of health care providers was distributed via e-mail within a large health system in the NY Metropolitan area. The survey was distributed in April and May of 2017. The specific aim was to collect information about health care providers’ perspectives on the use of MM in general and for specific medical conditions. Results: The sample (n = 137) consisted of 4% RNs, 10% NPs, 10% fellows, 21% resident physicians, and 52% attending physicians. Average experience was 13 years (range: 0-43), half (53%) were under 40 years old and just over half (56%) were female. Most practitioners recognized a benefit of MM for the treatment of cancer-associated symptoms, few were concerned with side effects and 5% of responders answered that MM was not appropriate at any stage of illness. Responders were “most likely to recommend or refer MM if other therapies were not effective” for cancer (83%), chronic pain (68%), spinal cord injury with spasticity (50%), MS (46%), epilepsy (42%), neuropathy (42%) and Parkinson’s disease (41%). Most providers (77%) believed that MM has the potential to reduce overall opioid use, this was found to be statistically more common in younger providers. The most common conditions that providers reported their patients were requesting MM for were cancer (37%), chronic pain (26%) and neuropathy (10%). The most common concerns about MM use were side effects (16%), addiction (13%), legal consequences (11%), cost (7%) and that other providers would judge MM use (7%). Conclusions: Our survey shows that providers are overwhelmingly in support of MM use in patients with chronic illness, particularly in cancer patients. However providers describe significant and practical concerns about MM utilization. Given the rate at which MM is being legalized throughout the country, it is imperative that there be increased focus on education and clinical studies on MM.