bluuebunny/crossref_metadata_2025_split huggingface dataset:
Palliative care research skill development needs: Lessons from the Palliative Care Research Cooperative Group (PCRC).
Authors: Ritchie Christine , Abernethy Amy P , Aldridge Melissa , Morrison R. Sean , Kutner Jean 
Published: February 2017

174 Background: The field of palliative care (PC) has grown substantially over the past decade. PC research has not kept pace, however. One contributing factor is the paucity of clinical investigators equipped to conduct rigorous PC studies, especially multisite studies focused on interventions, dissemination and implementation. A core mission of the Palliative Care Research Cooperative (PCRC) is to enhance investigator capacity to conduct applied patient/caregiver-centered research. Methods: The PCRC Investigator Development Center (IDC) performed two needs assessments in 2015: 1) PCRC methodologic Core Directors; and 2) a subset of PCRC junior investigators. Results: Through these two assessments, PCRC identified the following knowledge/skills gaps in planning and implementing multisite clinical trials and implementation research: basic principles of clinical trials, nuts and bolts of multisite clinical trials, special considerations in behavioral and pragmatic clinical trials, testing treatment efficacy vs testing treatment effectiveness, selection of endpoints and measurement tools, recruitment and adherence issues unique to palliative care populations, data safety monitoring, budgeting and development of protocols/training for multi-site trials. These knowledge/skills gaps were identified by junior investigators as well as by senior investigators whose prior experience is primarily with single-site studies or secondary data analyses. Conclusions: Advancement of PC research requires upskilling of investigators n conduct of multisite studies. The PCRC is partnering with the National Palliative Care Research Center (NPCRC) to make available a range of investigator development resources, including one-on-one mentoring, grant review support, webinars and palliative care research boot camps.
A cross-sectional view of radiation fractionation schemes used for painful bone metastases (PBM) cases within the Veterans Health Administration Radiation Oncology Centers.
Authors: Dawson George Anthony , Glushko Ignat , Hagan Michael Philip 
Published: February 2017

177 Background: Though the use of single fraction (SF) radiotherapy in the treatment of PBM is an integral component of frontline palliative radiotherapy in Canada and Europe ((Popovic - Radiotherapy and Oncology 111 (2014) 11–17), its use in the United States is only now gaining clinical acceptance. Recently, VHA Radiation Oncologists reported that roughly 76% offer SF to patients with a limited life expectancy (J Palliat Med. 2014 Nov;17(11):1221-5). In this cross-sectional report, we examine the actual dose fractionation schemes used for PBM cases by VHA Radiation Oncologists. Methods: METHOD: An electronic request was sent to 38 of 39 active VHA RO centers asking them to provide the radiation dose fractionation scheme used in the last 10 of their cases of PBM - (International Classification of Diseases (ICD) 198.5 - secondary malignancy of bone and or bone marrow). The study period: 03/01/2015 to 03/16/2015; Response rate: 100%. Data was provided for 382 cases . The survey results were divided by regions, and the 18 Veterans Integrated Service Networks (VISN) w/ VHA RO Centers. Results: RESULTS: According to the 382 cases analyzed, the top 3 fractionation schemes used were: 1st 300cGy x 10 (169); 2nd 800cGy x 1 (69); 3rd 400cGy x5 (63). Overall, SFRT was used in 18% of cases reviewed. There was, however, substantial variation across Veterans Health Administration. While radiation oncology practices in four Veterans Integrated Service Networks (VISN) used SFRT in 50% or more of their reported cases, practices in seven VISNs used SFRT in only 10% or fewer cases. Single fractions and Hypofractionation (3-7) was more common, comprising 45% of the cases. Conclusions: Compared to prior published data, these results suggest that in addition to our previously reported wide availability of hypofractionation for Veterans receiving palliation, actual increased use of Single Fraction and Hypofractionated radiotherapy for PBM is now common within the VHA. VHA RO are using SFRT per the ASTRO 2013 Choosing Wisely Campaign. [Table: see text]
Effects of the education program for patients with cancer pain.
Authors: Koh Su-Jin , Keam Bhumsuk , Seo Jeong Ju 
Published: February 2017

193 Background: Caner pain is prevalent, burdensome, and undertreated. Barriers to good cancer pain control exist within patients on lack of knowledge or poor attitudes towards pain and opioid analgesics. The objective of this study was to test the effects of an education program on reducing barriers to pain management in oncology. Methods: Participants completed baseline assessments and were randomly allocated to receive an education program or not in addition to standard care. Education materials for the pain management program included the ‘Guideline on cancer pain management for patients’. The average education time took basically 30 minutes, and CRNs implemented the education program using a booklet for an individual patient. Outcome measures at one week included the Barriers Questionnaire (BQ), Brief Pain Inventory. Adherence of analgesia and daily activity score were assessed. Results: 176 participants were recruited from 5 sites over 3 months. Mean average pain and worst pain score (NRS) improved significantly in patients receiving education program 1.40 and 1.61. The addiction subscale of the BQ score was improved by 1.95 (pre: 3.39, post: 1.44, p < 0.001) for participants receiving pain education. In terms of administration of short-acting analgesics due to breakthrough pain, inpatients showed no large difference before/after education in the use of short-acting analgesics but outpatients exhibited an increase from 25.5% before education to 73.5% after education and the difference was statistically significant. Conclusions: A cancer pain education was effective in reducing patient's barriers to pain management, improving pain score and daily activity score of cancer patients, especially using short-acting analgesics for breakthrough pain control in outpatients.
Use of medical cannabis to reduce pain and improve quality of life in cancer patients.
Authors: Cudmore Jessica , Daeninck Paul Joseph 
Published: February 2017

198 Background: Early attention to pain and symptoms in those with cancer improves both quality of life and survival. Opioid medications are the mainstay treatment of cancer-related pain. Cannabinoids are increasingly used as adjunctive treatments for cancer pain, but clinical evidence supporting their use as an “opioid sparing agent” or to improve quality of life is as yet unknown. Our study sought to determine if the addition of cannabinoids (medical cannabis) resulted in the reduction of the average opioid dose required for pain control, and improve self-reported quality of life indices. Methods: A retrospective chart review of cancer patients followed in our CCMB Pain and Symptom Clinic was conducted. Inclusion criteria: age over 18 years and formal enrollment in Health Canada’s Marihuana for Medical Purposes (MMPR) program (n = 24). Average dose of opioids were calculated in milligrams of morphine equivalent (ME) per day at the last documented visit prior to enrolment in the MMPR and then at the subsequent clinic visit. Averages of self-reported ESAS scores (pain, tiredness, drowsiness, nausea, appetite, depression, anxiety, sense of wellbeing) were calculated for the same visits. Statistical analysis using the paired student’s t-test compared means and determined the significance of any changes. Results: Following enrolment in the MMPR, the average opioid dose decreased by 70.375mg of MEs (p = 0.29). Self-reported ratings (10-point Likert scale) in pain (0.75, p = 0.23), tiredness (0.58, p = 0.21), drowsiness (1.125, p = 0.04), nausea (1.125, p = 0.04), appetite (1.42, p = 0.04), depression (1.29, p = 0.02) and anxiety (1.58, p = 0.004) improved after enrolment. Sense of wellbeing ratings did not change. Conclusions: Patients with cancer pain benefited from the addition of cannabinoids. The average opioid dose decreased following access to medical cannabis. Self-reported ratings of several quality of life indicators showed statistically significant improvement. Our study shows a signal that cannabinoids may reduce cancer patients’ reliance on opioids to control pain. Further prospective controlled studies are needed to further elucidate the role of cannabinoids in the treatment of cancer pain.
Prevalence of vitamin D deficiency among palliative care cancer outpatients: Prospective analysis of 347 cases of single individual medical practice.
Authors: Wojtacki Janusz , Labuc Agnieszka , Banach Piotr 
Published: February 2017

204 Background: In spite of the fact that cancer patients under palliative care represent the group of high risk for vitamin D deficiency (e.g. changed nutritional patterns and UV exposure), data reporting vitamin D levels in palliative care setting are rather scarce. Methods: Between Jan-02/2014 and June-20/2015 circulating 25-hydroxyvitamin-D (25-OH-D) levels were analyzed in 76% consecutive patients’ samples of a single individual cancer practice located in Gdansk, Poland. Three hundred forty seven patients (female: 72.5%, median age 64, range: 23-89 years; breast cancer: 57.8%, colon cancer 27.7%) were admitted for palliative care due to: disseminated cancer (18%), side effects of anticancer therapy (56.6%) or symptom control in non-cancer diseases (24.5%). Results of fast 25-OH-D blood tests were correlated with selected clinical factors. Results: The median 25-OH-D level of all our cohort patients was 15.85 ng/mL (range: 0.40 – 62.00 ng/mL); 65.0% of subjects were vitamin D deficient (25-OH-D < 20 ng/mL) and 23.5% insufficient (20-30 ng/mL); only 3.30% patients were taking vitamin D supplements before they entered the study. The univariate analysis identified the following risk factors for inadequate 25-OH-D levels: active cancer disease (median 25-OH-D: 12.50 ng/mL versus 17.86 ng/mL in patients without evidence of disease, p < 0.001) and current glucocorticoids use (at least 14 days within the last month: 11.58 ng/mL versus 17.12 ng/mL in glucocorticoids nonusers; p < 0.01). Age, gender, body mass index values, primary cancer location, dominant metastatic site and higher antibiotics use did not influence 25-OH-D levels. Conclusions: 1) Low (deficient or insufficient) 25-OH-D serum levels were highly prevalent in palliative cancer care outpatients, mostly in those with clinically active disease and using glucocorticoids; 2) the study will continue to address the correlation between 25-OH-D concentrations and symptom burden as well as the potential feasibility of vitamin D supplementation to improve symptoms management of patients in palliative care setting.
Potentially avoidable hospitalizations in older patients with acute myeloid leukemia (AML).
Authors: El-Jawahri Areej , Keenan Tanya , Abel Gregory Alan , Steensma David P. , LeBlanc Thomas William , Traeger Lara , Fathi Amir Tahmasb , DeAngelo Daniel J. , Wadleigh Martha , Hobbs Gabriela , Amrein Philip C. , Stone Richard M. , Ballen Karen K. , Chen Yi-Bin Albert , Temel Jennifer S. 
Published: February 2017

206 Background: Many older adults ( ≥ 60) with AML have a poor prognosis and spend a significant portion of their life from diagnosis until death in the hospital. We examined the reasons for hospitalizations and identified potentially avoidable hospitalizations. Methods: We conducted a retrospective analysis of 200 patients ( ≥ 60) diagnosed with AML between 1/1/2006 and 10/30/2011 at two hospitals in Boston to examine the reasons for hospitalizations during treatment. Practicing physicians used a consensus-driven medical record review process to identify primary reason for each hospitalization and categorize it as “potentially avoidable” or “not avoidable” based on a novel adaptation of the Graham’s criteria for potentially avoidable hospital admissions. We compared the rate of potentially avoidable hospitalization between older patients receiving intensive chemotherapy (n = 124) versus non-intensive chemotherapy (n = 76) using Fisher’s Exact test. Results: We evaluated 627 hospitalizations after the diagnosis of AML in 200 unique patients. The median age was 69 years [range 60-90] and the median number of hospitalizations was 4.0 [range 0-18]. 33.2% of patients underwent stem cell transplantation. The most common primary reasons for hospitalizations were: fever/infection (38.3%), planned hospitalizations for chemotherapy or transplantation (35.9%), and uncontrolled symptoms (10.5%). We identified 108/627 hospitalizations (17.2%) as potentially avoidable. Among potentially avoidable hospitalizations, 40.7% were due to premature hospital discharge, 22.2% could have been managed in the outpatient setting, 13.9% failed to have timely outpatient follow-up, and 13% were due to patients’ medication non-adherence. There were no differences in potentially avoidable hospitalizations between patients receiving intensive vs. non-intensive chemotherapy (16.9% vs. 17.8%, P = 0.83). Conclusions: Most hospitalizations in older patients with AML are unavoidable and driven by the illness course and its treatments. However, a minority of hospitalizations is potentially avoidable and should be the focus of future interventions to reduce health care utilization and the burden of AML on this population.
Efficacy and safety of rolapitant for prevention of chemotherapy-induced nausea and vomiting (CINV) in patients (pts) receiving anthracycline-cyclophosphamide (AC)-based chemotherapy.
Authors: Powers Daniel , Schnadig Ian D. , Modiano Manuel R. , Arora Sujata , Schwartzberg Lee Steven 
Published: February 2017

208 Background: Rolapitant, a novel NK-1 receptor antagonist, demonstrated efficacy in the prevention of CINV in pts receiving moderately- or highly emetogenic chemotherapy (MEC; HEC). In this post-hoc analysis, we evaluated safety and efficacy outcomes in pts receiving AC-based therapy, now considered HEC. Methods: This double-blind, active-controlled study randomized pts to oral rolapitant 180 mg plus granisetron 2 mg and dexamethasone 20 mg or granisetron/dexamethasone alone (active control). Complete response (CR = no emesis and no use of rescue medication), no emesis, no significant nausea, and time to emesis or rescue medication during overall, acute, and delayed phases and treatment-emergent adverse events (AEs) are presented. Results: 703 pts received AC-based therapy, of which 97% had breast cancer. CR was significantly higher for rolapitant vs. active control for delayed and overall phases in pts receiving AC-based therapy (Table). Time to first emesis or use of rescue medication was significantly longer with rolapitant vs. active control (between-group comparison, p = 0.032); median was not reached in either treatment arm. A significantly greater proportion of pts on rolapitant (73.0%) vs. active control (60.2%) had no emesis during the overall phase (p < 0.001). Rates of no significant nausea were similar for rolapitant (63.7%) and active control (62.4%) in the overall phase (p = 0.728). Treatment-related AEs (TRAEs) during Cycle 1 occurred in 8.7% and 8.8% of pts on rolapitant vs. active control. Most frequent TRAEs were constipation (2.9% vs. 2.7%), fatigue (2.3% vs. 2.2%), and headache (2.3% vs. 3.3%). Conclusions: Rolapitant was superior to active control in preventing CINV during delayed and overall phases after AC-based chemotherapy. The safety profiles of the rolapitant and control arms were similar. These results are consistent with those of the overall pt population in this study. Clinical trial information: NCT01500226. [Table: see text]
A prospective survey of depressive disorder among patients with advanced lung cancer in South China.
Authors: Zhang Li , Sheng Jin , Liu Xia , Yang Yunpeng , Ma Yuxiang , Huang Yan , Zhao Hongyun 
Published: February 2017

216 Background: Depression frequently compromises quality of life and prognosis for patients with cancer. However, this psychiatric disorder is often overlooked. This ongoing multi-center investigation was designed to prospectively evaluate the prevalence of depressive disorder in patients with advanced lung cancer in South China. Methods: Patients diagnosed with advanced lung cancer will be screened by two items from the nine-item Personal Health Questionnaire (PHQ-9). For individuals who endorse either item (or both) as occurring for more than half of the time or nearly every day within the last 2 weeks (ie, score of ≥ 2), the remaining 7 items are suggested to be completed. Patients will receice standard palliative chemotherapy according to the preference of oncologists. Demographic variables and clinical information were statistically analyzed. Results: By now, this study have enrolled 97 patients for initial screen, 58 (59.8%) were chemotharapy-naïve. Based on the PHQ-9 questionnaire, the percent of patient suffered from various degree depressive symptomes was 76.3% (74 patients). 51.5% patients (50 cases) were proved with mild depressive symptomes but not met the criteria for depression. Meanwhile, the incidence of moderate or severe depression were separately 17.5% and 7.3%. There were few consistent correlates of depression. Hitherto, 49 patients completed the second investigation after 1or 2 cycles of palliative chemotherapy. In terms of the PHQ-9 score, no statistically significant difference was detected around cytotoxic treatment (mean value: 6.67 and 6.43, p = 0.65). Although the mild depressive symptomes were decreased from 53.1% to 42.9% after palliative chemotherapy, the percent of moderate or severe depression remained the same (17/49, 34.7%). Conclusions: The preliminary result showed that the incidence of depressive disorder among patients with advanced lung cancer may be underestimated. No evidence was found yet to demonstrate the impact of demographic variables on depression. There is unmet need for psychological intervention for advanced lung cancer patients with depressive disorder, especially for those with moderate or severe degree at diagnosis.
Health behaviors and coping among informal caregivers of lung and colorectal cancer survivors: Distribution and interrelationships.
Authors: Kent Erin E. , Litzelman Kristin , Rowland Julia Howe 
Published: February 2017

229 Background: Family/informal caregivers play a critical role in the palliative care and support of cancer survivors, yet are at risk of poorer health outcomes than non-caregivers. Self-care, including positive health behaviors and coping, are important for long-term caregiver well-being, and potentially that of care recipients. This study sought to evaluate the distribution of and interrelationships among health behaviors and coping strategies among cancer caregivers. Methods: This study used data from the Cancer Care Outcomes Research & Surveillance Consortium (CanCORS). Caregivers reported by survey their health behaviors, coping, and sociodemographic and caregiving characteristics. Descriptive statistics assessed the distribution of caregivers’ health and coping behaviors, and multivariable linear regressions assessed the associations between health behaviors and coping styles. Results: Many caregivers reported positive health behaviors (i.e., moderate physical activity, adequate sleep, low rates of binge drinking). Caregivers most frequently reported using emotion-focused coping styles (religion, acceptance, positive reframing, emotional support). Caregivers reporting higher levels of physical activity or feeling less well-rested used problem-focused coping styles more frequently (Effect sizes [ES] up to 0.21, p < 0.05) . Those with some physical activity (1-149 minutes/week vs none) scored higher on emotion-focused coping, while drinkers (1+ drink in the past 30 days vs 0) and binge drinkers (5+ drinks in a row vs 0) scored lower on this subscale (ES = 0.16, 0.12, and 0.25; p < 0.05). Caregivers reporting current smoking (ES = 0.21), binge drinking (ES = 0.49), and feeling less well-rested (ES up to 0.48) scored higher on dysfunctional coping (p < 0.05). Conclusions: Caregivers’ health behaviors and coping strategies were interrelated. Interventions targeting both factors concurrently may be particularly efficacious at improving family caregiver self-care, potentially improving caregiving quality and patient-centered palliative care. Future research is needed to design and test such interventions and the potential impact on palliative care.
Correlates of and interrelationships among social stressors, relationship quality, and family functioning among informal cancer caregivers.
Authors: Kent Erin E. , Litzelman Kristin , Rowland Julia Howe 
Published: February 2017

230 Background: Informal/family caregivers play a critical role in supporting cancer patients and are often an important part of the palliative care team. To better understand how informal caregivers are influenced by their role and inform future interventions, this study sought to evaluate the distribution and correlates of social and family factors among caregivers of cancer patients. Methods: This cross-sectional study used data from the Cancer Care Outcomes Research & Surveillance Consortium (CanCORS). Lung and colorectal cancer patients nominated an informal caregiver to participate in a caregiving survey. Caregivers reported their sociodemographic and caregiving characteristics, social stress, relationship quality with the patient, and family functioning. Descriptive statistics were used to assess the distribution of caregivers’ social factors. Multivariable linear regressions were used to examine the independent correlates of each social factor. Results: Most caregivers reported low-to-moderate levels of social stress and good relationship quality and family functioning. In multivariable analyses older age was associated with lower social stress and better family functioning, but worse relationship quality, with effect sizes (Cohen’s D) up to 0.40 (p < 0.05). Caring for a female patient was associated with lower social stress and better relationship quality, but worse family functioning (effect sizes up to 0.16, p < 0.05). Few caregiving characteristics were associated with social stress, while several were significant independent correlates of relationship quality. Finally, social factors were important independent correlates of one another. Conclusions: The results highlight the importance of personal and caregiving-related characteristics and the broader family context to social factors. As social factors may play an important role in the health, quality of life, and caregiving efficacy of informal caregivers, future work is needed to better understand these pathways and assess whether interventions targeting social factors can improve caregiver well-being, thereby potentially improving patient-centered palliative care.