bluuebunny/crossref_metadata_2025_split huggingface dataset:
Factors affecting adherence to standard cisplatin (CDDP)-based chemotherapy regimen for locally advanced squamous cell head and neck (H&N) cancer in an inner city safety net hospital.
Authors: Singh Sunny R K , Malapati Sindhu Janarthanam , Lu Pei , Rosen Fred R. 
Published: November 2017

252 Background: The non-operative standard of care for advanced, non-metastatic H&N cancer is high dose CDDP (100 mg/m2) given every 21 days for 3 cycles concurrent with radiation. Many patients are either started on or switched to an alternative regimen due to pre-treatment co-morbidities or development of CDDP related toxicity. In clinical practice, the percentage of patients not receiving current standard of care and reasons thereof are not well defined. This and the consequence of such deviation from treatment is what we propose to study. Methods: This is a retrospective study including 45 patients from 2014-2016 with advanced, non-metastatic H&N cancer treated with definitive concurrent chemoradiation. All patients were evaluated by ENT, Medical and Radiation Oncology and were presented to the multidisciplinary H&N Tumor board. Results: In the studied population, 73.3% were African Americans , 82.2 % males, 91.1% smokers and 97.7 % ECOG 0-1 at presentation. In all, 11.1% patients were unable to receive CDDP and received an alternate drug because of frailty, ECOG 2 status, pre-existing CKD, hearing problems or neuropathy. Of the 40 patients (88.8%) receiving CDDP, only 8 (17.7%) completed 3 cycles on schedule without changes. Of the remaining 32 (71.1%) receiving CDDP, 13 (40.6 %) were switched to alternate drug and 19 (59.3%) required only a dose decrease/delay. The reasons included CDDP related toxicity (54.05%), frailty or comorbidities (27%), worsening ECOG and fluid overload due to CDDP associated hydration. Toxicities leading to change in regimen included mostly AKI (63.15%) and also neutropenia, ototoxicity, nausea, vomiting and diarrhea. Mean duration of radiation therapy in patients receiving standard regimen was 52.2 days and in patients deviating from standard regimen was 55.1 days. Data supporting trend of poorer outcomes in those who deviate from standard regimen will be reported later. Conclusions: Majority of patients (82.2%) with advanced, non-metastatic H&N cancer being treated with definitive concurrent chemoradiation deviate from standard of care CDDP regimen with at least half due to cisplatin related toxicity.
Ultrasound application in point of care by palliative medicine physicians: Initial experience of oncology palliative medicine consultation in two rural area hospitals in Costa Rica.
Authors: Villalobos Karol 
Published: November 2017

254 Background: Point of care Ultrasonography (POCUS)—that is ultrasonography performed and interpreted by the clinician at the bedside—is a method of clinical focused evaluation assisted by ultrasound equipment which gives the health provider in limited resources conditions, a prompt and accurate diagnosis for a limited number of pathologies. Development of portable ultrasound equipment with accessible technologies in terms of health investment, allows developing such practice in non-conventional resource-limited settings as patient homes. Our proposal is to show point of care ultrasonography (POCUS) experiences by two Palliative Care specialist doctors with in government-managed Social Security service (CCSS) in rural areas in Costa Rica. Methods: Limited diagnosis examinations were performed both at the hospital as well as at out of hospital sites in rural areas of Turrialba, and San Carlos, Costa Rica. Percutaneous procedures took place at the hospital following monitoring and aseptic standards, using two different units (Contec CMS600P2B, Phillips Clearvue 550). Results: Each brief case presented in this article shows effective Point of Care Ultrasound uses for patients with life-limiting conditions in resource-limited settings. Use of this technology by palliative medicine specialists in these cases helped patients and their families by accelerating right diagnosis, limiting unnecessary hospital transportation or by helping making safer procedures. Conclusions: Point of care ultrasound usage by palliative medicine specialists is an innovation breaking paradigms that has shown in our case to be a successful help as an evaluation strategy in a limited-resources rural environment, with a frail population.
Effects of examination room computer on cancer patients perception of physician's compassion, communication skills, and professionalism: A randomized clinical trial.
Authors: Haider Ali , Tanco Kimberson Cochien , Epner Margeaux , Azhar Ahsan , Williams Janet L. , Frisbee-Hume Susan , Allo Julio A. , Liu Diane D , Bruera Eduardo 
Published: November 2017

26 Background: The use of electronic health records (EHR) continues to rise in various clinical settings. The full effects of EHR use on physician-patient interactions remain unclear. This study aims to compare patient perception of physician’s compassion, communication skills, and professionalism between a traditional face to face clinic visit with a visit where an examination room computer is used by the physician to access and document patient information. Methods: RCT was conducted at an outpatient supportive care center. 120 English speaking adults with advanced cancer were recruited. Patients were randomized to watch 2 standardized, 3-minute video vignettes depicting a routine physician-patient clinical encounter. Both videos had identical script. In one video, physician communicated face to face while in the other video physician used the examination room computer during conversation. Both actors and patients were blinded to the purpose of the study. Investigators were blinded to the sequence of videos watched by the patients. After viewing each video, patients completed validated questionnaires rating their perception of physician’s compassion (0 = best, 50 = worst), communication skills (0 = poor, 70 = excellent) and professionalism (0 = poor, 20 = very good). Patients were also asked to rate their overall physician preference. Results: After watching the first video, the face to face clinical encounter resulted in better compassion scores (median [interquartile range], 9[0-18] vs 20[6-28]; P = .0003), communication skills 65[54-70] vs 54[41-63]; P = .0001) and professionalism 19[5-20] vs 14[11-17]; P = .013). After crossover analysis, we found a significant period ( P = .004) and sequence ( P = .005) effect favoring the second video on compassion scores. After watching the second video, 86 (72%) of the patients preferred face to face communication. Conclusions: Patientsperceived physicians who communicated face to face without the use of computer as more compassionate, professional and with better communication skills. Moreover they preferred face to face physician to be their provider. Clinical trial information: NCT02957565.
Understanding the goals of chemotherapy for metastatic cancer: A survey of patients receiving palliative treatment in the Philippines.
Authors: Cauton Pauline Anne Peronilla , Francia Marie Belle Dela Cruz 
Published: November 2017

28 Background: Chemotherapy for metastatic cancer is, for most cases, primarily given with palliative intent. An unrealistic expectation of cure with chemotherapy can influence a patient’s decision to receive treatment with significant physical, financial and psychological effects. This study describes how patients receiving palliative chemotherapy view their illness and treatment. Methods: Patients receiving chemotherapy for metastatic cancer were asked about their understanding of treatment goals using a questionnaire based on portions of the Cancer Care Outcomes Research & Surveillance (CanCORS) survey. The prevalence of responses reflecting a belief of cure with chemotherapy was determined. Additional information gathered included other expectations and attitudes towards illness and treatment. Results: A total of 90 patients receiving treatment at St. Luke’s Cancer Institute participated. Ninety-five percent (n = 85) said they believed chemotherapy could, however likely, cure their cancer. The likelihood of having an unrealistic expectation about chemotherapy was high regardless of sex, age, civil status, social class, educational attainment, cancer type, illness duration, and number of lines of treatment received. As for other expectations of chemotherapy, majority agreed that chemotherapy was somewhat likely to prolong life (51.1%), achieve symptom control (51.1%), and have side effects (50%), yielding a pattern of responses almost identical to the ones about cancer cure. Patients said they worried most about treatment cost and side effects. Despite this, an overwhelming percentage said they would choose to pursue life-prolonging treatment no matter what the cost (physically and financially). Less than half (43.7%) expressed an openness to discuss advance directives with their doctor. This could be seen as an extension of their inaccurate understanding of prognosis, or conversely as a manifestation of avoidance or denial. Conclusions: Many factors influence a patient’s perception of his/her illness and treatment. Further study on specific patient and physician factors may identify key areas of improvement for effective communication.
Systematic review on shared decision making for patients with lung cancer: Effects on distress and health care utilization.
Authors: Geerse Olaf , Stegmann Mariken , Kerstjens Huib A.M. , Hiltermann Thijo Jeroen Nicolaas , Bakitas Marie , Zimmermann Camilla , Deal Allison Mary , Berger Marjolein , Berendsen Annette J. 
Published: November 2017

31 Background: Lung cancer is associated with significant distress, poor quality of life, and a median prognosis of less than one year. Shared decision making (SDM) has been recommended as a strategy to help guide patients facing difficult treatment trade-offs. Potential benefits of SDM include enhanced knowledge and better congruence between treatment decisions and patients’ personal values and have been described in multiple diseases. We investigated the impact of SDM on distress and healthcare utilization among patients with lung cancer. Methods: We performed a systematic literature search in the CINAHL, Cochrane, EMBASE, MEDLINE, and PsychINFO databases. Studies were eligible when conducted among patients with lung cancer, evaluated SDM, and measured distress and/or health care utilization as outcomes. Risk of bias was assessed using the Cochrane risk of bias tool. Results: A total of 11 articles were identified: two retrospective cohort studies and nine articles reporting on eight randomized controlled trials. Overall, the risk of bias of included studies was low, except for a high risk of bias concerning blinding of participants or personnel. All studies reported on a broad supportive care intervention with SDM as a component of the intervention. No beneficial effect was found in five studies measuring generic distress, while one study reported beneficial effects on depression. There was conflicting evidence regarding the effects of SDM on healthcare utilization; of the seven studies analyzing this, five studies found evidence for a reduction in healthcare utilization. Conclusions: Although relevant, only scarce evidence is currently available on the effects of SDM on distress and healthcare utilization among patients with lung cancer. Thus, additional research is needed before SDM can be recommended in the lung cancer context.
Anxiety in breast cancer patients treated with neoadjuvant therapy: Effects on surgical plan and role of supportive care.
Authors: Li Huaqi , Cheung Winson Y. , Myers Paula , McKevitt Elaine , Willemsma Kaylie , Deruchie Tan Adam , Chia Stephen K. L. , Simmons Christine E. 
Published: November 2017

35 Background: The impact of high anxiety on surgical decision making has been demonstrated in various cancer settings. For patients undergoing neoadjuvant therapy (NAT) for breast cancer, supportive services can be offered prior to surgery and may help them choose between the options of bilateral mastectomy, unilateral mastectomy, or breast conserving surgery (BCS) where clinically appropriate. However, the effect of anxiety at initial diagnosis and psychological support on these decisions has not yet been studied. Methods: A prospective database of breast cancer patients treated with NAT at the British Columbia Cancer Agency was utilized to extract demographic information, surgical plan with regards to BCS and unilateral or bilateral mastectomy, and information about supportive services utilized. This was correlated with anxiety scores at initial consultation recorded by the Edmonton Symptom Assessment System and the Psychosocial Screen for Cancer. Patients were excluded if they had bilateral breast cancer, BRCA mutation, or missing data. Fisher’s exact tests were applied for statistical analysis. Results: From 2012-2016, 361 potential patients were identified. In total, 203 patients met eligibility criteria: 93 patients (46%) had low anxiety and 110 patients (54%) had high anxiety. Patients with high self-reported anxiety at initial consultation were 19% more likely to undergo aggressive surgery (bilateral mastectomy for unilateral disease or mastectomy for BCS eligible disease) than those with low self-reported anxiety at initial consultation (37% VS 18%; p = 0.003). Of the 110 patients with high anxiety, only 46 patients (42%) utilized counselling before surgery. No significant difference in rate of aggressive surgery was observed in patients with high anxiety who had counselling compared to those who did not (33% VS 41%; p = 0.43). Conclusions: High anxiety at initial consultation is associated with a 19% increase in aggressive surgery compared to patients with low anxiety. Counselling resources are currently underutilized by eligible patients, but this did not have an impact on surgical decision making in this study. This may be an area of opportunity for further research.
Preoperative evaluation of older cancer patients: Why some patients did not proceed with planned surgery.
Authors: Williams Taylor Raines , Alexander Koshy , Korc-Grodzicki Beatriz , Sarraf Saman , Shahrokni Armin 
Published: November 2017

38 Background: Older cancer patients may need to make challenging treatment decisions at the time of preoperative evaluation. This study assesses the reasons and outcomes of older cancer patients who did not proceed with planned surgery. Methods: This is a retrospective analysis of a cohort of 1767 older cancer patients who presented to the Geriatrics clinic for preoperative evaluation between 1/2015 and 12/2016. Differences in Geriatric Assessment between those who proceeded and did not proceed with surgery were assessed within a month after preoperative evaluation. Charts of those who did not proceed with surgery were reviewed to identify the reasons, and outcomes of those patients. Results: In total, 114 out of 1767 (6.5%) did not proceed with surgery. Functional status played an important role in this decision. Among patients with Karnofsky Performance Scale (KPS) of 80+, 20% had their procedure in another institution; this was 0% for patients with KPS 70-. 61% of patients with KPS 50 opted for surveillance or supportive care, compared to 37% and 32% of those with KPS 60-70 and 80+, respectively. Reasons cited for not medically clearing the patients also differed. 60% and 69% of those with KPS 80+ and 60-70 were not cleared based on comorbid conditions, compared to 44% of those with KPS 50-. On the other hand, 44% of patients with KPS 50- had documented frailty as a reason for not getting clearance, compared to 15% and 23% of those with KPS 80+ and KPS 60-70. Conclusions: Geriatricians play an important role in helping patients reach proper medical decisions at the time of surgery. Future studies should look at various interventions that may assist older cancer patients/caregivers in their decision making at the time of surgery.
Shared understanding: Predicting home hospice nurse-cancer family caregiver communication similarity.
Authors: Reblin Maija , Kane Lauren , Baucom Brian R , Clayton Margaret F. , Ellington Lee 
Published: November 2017

40 Background: In cancer home hospice, families provide 24/7 care with support from a nurse-led hospice team. Effective patient-caregiver-nurse communication can facilitate a “shared understanding,” resulting in better patient caregiver outcomes. Shared understanding may be evidenced by high similarity in language usage/meaning. Objective: Describe communication caregiver-nurse similarity (relatedness in word usage/meaning) in cancer home hospice using latent semantic analysis (LSA) and to identify nurse communication processes, confidence, and preferences that predict communication similarity. Methods: As part of a larger study, nurse home hospice visits to spouse cancer caregivers were audio recorded. Interaction analysis was used to quantify caregiver and nurse emotion talk, nurse partnering, and nurse dominance (ratio of total nurse/caregiver talk). Nurses completed questionnaires to capture preference for patient oriented care and confidence in their communication. Verbatim transcripts were analyzed using LSA, a tool that assesses the similarity of communication (range 0-1 where higher scores indicate greater similarity). Descriptive statistics and bivariate correlations were calculated. Results: 31 nurse-caregiver home hospice interactions were analyzed. Nurses were female, average age 44.03 (SD = 9.8), with an average 14.6 years experience. Spouse caregivers were 77% female, average age 64.7 (SD = 10.9). The average LSA score was .83 (range = .66-.89). Higher LSA values were significantly associated with more nurse partnering (r = .36, p = .05) and lower nurse dominance (r = -.39, p = .03), but not caregiver or nurse emotion talk (ps > .05). Higher LSA values also predicted more nurse-reported preference for patient-oriented care (r = -.75, p < .01) and lower nurse communication confidence (r = -.46, p = .01). Conclusions: Our findings suggest that hospice nurses who are more patient-oriented, listen to and encourage caregivers’ concerns are more likely to use concordant meaning and language usage in their home hospice visits. Further research should examine if a nurse’s use of language similarity strategies improve caregiver understanding, competency and satisfaction with care.
Perceptions of prognosis and treatment risk in older patients with acute myeloid leukemia (AML).
Authors: Nicholson Showly , Abel Gregory A. , Fathi Amir Tahmasb , Steensma David P. , LeBlanc Thomas William , DeAngelo Daniel J. , Wadleigh Martha , Hobbs Gabriela , Foster Julia , Brunner Andrew Mark , Amrein Philip C. , Stone Richard M. , Temel Jennifer S. , El-Jawahri Areej 
Published: November 2017

43 Background: Older patients ( > 60 years) with AML face difficult treatment decisions as they can be treated either with risky multi-drug intensive chemotherapy for a small chance of a cure, or non-intensive and non-curative palliative chemotherapy. However, studies have not described patients understanding of their prognosis and treatment risk. Methods: We conducted a longitudinal study of older patients newly diagnosed with AML at two tertiary care hospitals. At enrollment, we assessed patients and oncologists perception of treatment-related mortality. At one month, we assessed patients and oncologists perception of prognosis using the Prognosis and Treatment Perception Questionnaire. Results: We enrolled consecutive patients within 72 hours of initiating intensive (n = 50) or non-intensive (n = 50) chemotherapy. The majority of patients reported that it is somewhat (58/92, 63.0%) or extremely (26/92, 28.3%) likely to die due to treatment while their oncologists reported that it is very unlikely (80.0%; 74/92) for the patient to die due to their treatment (P < 0.001). Most patients (90.0%, 73/81) reported that they were somewhat or very likely to be cured of their leukemia while most oncologists reported that it is unlikely or very unlikely for the patient to be cured (74% (60/81)) (P < 0.001). Patients receiving both intensive and non-intensive chemotherapy had significant misperceptions about their prognosis (Table 1). Conclusions: Older patients with AML have substantial misperceptions regarding the risks of their treatment and they overestimate the likelihood of cure, compared to their oncologists estimates. Prognostic misperceptions are especially striking in patients receiving non-intensive chemotherapy. Interventions to facilitate communication are needed to ensure patients with AML have an accurate understanding of their treatment risks and prognosis and are therefore enabled to make informed decisions about treatment. [Table: see text]
The PULSES project: Teaching the vital elements of code status discussions to oncology residents.
Authors: Levine Oren Hannun , Menjak Ines B. , Brule Stephanie Yasmin , McConnell Meghan , Dhesy-Thind Sukhbinder K. , Mukherjee Som , Brouwers Melissa C. 
Published: November 2017

46 Background: Discussions with cancer patients around cardiopulmonary resuscitation, or ‘code status,’ are often led by trainees in oncology, but formal education for this competency is lacking. In this study, we developed and tested a novel communication tool, the PULSES framework, for informed code status decision-making (a six-step approach summarized by the PULSES acronym [see Table]), through an educational workshop. Methods: A multicentre randomized controlled trial was carried out at 3 academic cancer centres in Ontario, Canada. Residents in medical oncology (MO) and radiation oncology (RO) programs completed a workshop and an observed structured clinical exam (OSCE). Participants were randomized to complete the training before the OSCE (experimental arm) or after the OSCE (control arm). Randomization was stratified for centre and oncology discipline. Expert raters evaluated communication with two rating tools: the novel PULSES scale and the communication skills assessment form (CSAF), a validated benchmark tool that is not specific to oncology content. The primary outcome was improvement in PULSES scores. Results: Forty-six residents consented to participate (28 RO and 18 MO). Groups were well balanced for program and year of training. Participants in the experimental group had higher mean PULSES score than those in the control group (80.4±13.5 vs 63.4±9.7; p<.001; maximum score = 108). There was no significant effect for oncology program and no significant interaction between program and training condition. Scores from the PULSES and CSAF scales were highly correlated (R = 0.864). Conclusions: The PULSES training improved performance among oncology residents for code status discussions. Improved communication scores were not scale-specific. The PULSES framework offers a standardized approach and can be incorporated into competency-based curricula for postgraduate oncology programs. Future work will explore whether communication training in this area impacts patient-level outcomes. [Table: see text]