bluuebunny/crossref_metadata_2025_split huggingface dataset:
Multidisciplinary risk assessment to reveal cancer treatments in complex cancer patients.
Authors: Huillard Olivier , Boudou-Rouquette Pascaline , Chahwakilian Anne , Montheil Vincent , Thomas-Schoemann Audrey , Orvoen Galdric , Cabanes Laure , Durand Jean-Philippe , Cessot Anatole , Giroux Julie , Tesniere Antoine , Stephanazzi Jean , Mosnier-Pudar Helen , Alexandre Jerome , Goldwasser Francois 
Published: February 2017

170 Background: Older age is a cause of disparity in cancer treatment decision and treatment guidelines for patients with comorbidities, polypharmacy, denutrition or psycho-social frailty are needed. A pre-therapeutic multidimensional assessment might improve the complex patient management. We developed an experimental program of integrated medicine called ARIANE. We report 18 months activity of this outpatient setting evaluation, its feasibility and impact on treatment decision-making. Methods: Complex patients with predefined cancer treatment strategy entered into the program. A one-day evaluation combined consultations of cardiologist, geriatrician, diabetologist, anesthetist, pharmacist, pain specialist, dietician, psychologist and social worker. Evaluation of performance status, EKG, ejection fraction, ASA score, diabetes, social vulnerability and malnutrition was performed including a geriatric assessment, which focused on items like comorbidity (CIRS-G), dependance (ADL, IADL), fails (Up and Go Test), cognitive impairment (MMSE, Clock Drawing Test) and depression (GDS scale). A pharmacist assessed the risk of drug-drug interactions. Results: Eighty-seven pts, median age 81 years (range 25-94), 76% male, 51% PS 0-1, 77% grade 3 or 4 comorbidity were included. Genito-urinary, lung cancers and sarcoma represented 77% of pts. Eighty-two percent of pts were assessed by at least ≥ 7 participants. Identified factors of vulnerability were polypharmacy (n=65; 75%; >3 drugs), social distress or severe malnutrition (both n=21; 24%), depression (n=17; 19.5%) and cognitive impairment (n=13; 15%). We identified drug interaction in 18 pts (27%). The risk assessment resulted in anticancer treatment changes in 47/87 patients (54%): protocol adaptation (n=19/87; 22%), less aggressive treatment (n=15/87; 17.2%), or more intensive therapy (n=13/87; 15%). Conclusions: A one-day multidisciplinary risk assessment is an answer to the complexity of unfit cancer patients and improves the safety of anticancer treatments.
Meta-analysis of trials comparing standard antiemetic treatment (SAT) with aprepitant containing antiemetic regimens (ACAR) for prevention of chemotherapy-induced nausea and vomiting (CINV).
Authors: Gupta Neha , Hatoum Hassan , Al Ustwani Omar , Danchaivijitr Pongwut , Wang Katy , Pili Roberto 
Published: February 2017

171 Background: Various randomized controlled trials (RCTs) have shown improved outcomes with addition of aprepitant to standard antiemetic treatment (SAT) in preventing CINV. We conducted a meta-analysis to study the overall impact of ACAR in CINV prevention in adults. Methods: We searched Pubmed and Ovid databases, and American Society of Clinical Oncology meetings abstracts for RCTs using ACAR with SAT for CINV prevention in adult cancer patients (pts). Major study end points were complete response to treatment (CR; defined as no emesis and no use of rescue medications) in overall phase (OP; 0-120 hours of chemotherapy), acute phase (AP; 0-24 hours) and delayed phase (DP; 24-120 hours). Additionally, we assessed the control of nausea and toxicity profile (TP). Stouffer's Z-score method was used to calculate the overall effect. Results: 16 RCTs (5,547 pts) were included. 11 trials (3,314 pts) involved highly emetogenic chemotherapy (HEC) and 5 trials (2,233 pts) involved moderately emetogenic chemotherapy (MEC). ACAR increased CR in OP from 47% to 63% (OR=0.52, CI=0.46 to 0.58; p<0.001), in AP from 73% to 81% (p<0.01), and in DP from 51% to 66% (p<0.001). Significant increase in nausea control was seen in DP (p=0.03) but not in OP or AP. Incidence of various toxicities was statistically similar in both groups except slightly higher rate of fatigue (p=0.02) and hiccups (p<0.001), and lower rate of neutropenia (p=0.02) in ACAR. Conclusions: ACAR is effective in CINV due to both HEC and MEC in adult cancer pts. ACAR improves the control of emesis in all phases, and nausea in delayed phase only. With the exception of causing more fatigue & hiccups, and lesser neutropenia, overall TP of ACAR is similar to SAT.
Outpatient implementation of a patient self-reported symptom system in an integrated health system.
Authors: Adonizio Christian S. , Wojtowicz Mark , Wade James , Keifer Lisa , Graves Thomas , Darer Jonathan 
Published: February 2017

172 Background: To date, process-related outcomes dominate the landscape of the measurement of quality of oncologic care. Use of patient-reported outcomes has the potential to enhance value-based performance measurement. We performed a pilot study of integrating patient-reported data (PRD), into the daily work-flow of outpatient oncology clinics in an integrated health system, Geisinger Health System (GHS). Methods: All patients in the pilot were asked their pain scores by nurses according to existing procedures. In addition, the MD Anderson Symptom Inventory (MDASI) questionnaire was given to patients via touch screens in exam rooms. Four oncologists participated in the study at two sites. The study was reviewed by the GHS IRB and was granted exemption status. Results: 63 patients successfully used the touch screen monitors to complete the MDASI with minimal impact to clinic flow. Compared to the existing EHR-prompted nursing-collected pain score method, the PRD/MDASI method identified an additional 31% of patients with severe pain who were previously identified as having “no pain” (Table). 75% of patients identified as having “moderate pain” by the current method report “severe pain” by the PRD method. Conclusions: This pilot study demonstrates that the collection of PRD can be integrated into routine oncological clinic workflows with minimal interference with clinical flow. The study also shows that the collection of PRD may be superior to clinician screening at the time of the encounter alone. GHS will integrate PRD fully into its EHR in August 2014. GHS is developing evidence-based, standardized symptom management protocols and expanding the use of PRD in clinical care. [Table: see text]
Prevalence and correlates of patient symptom burden at initiation of curative chemotherapy.
Authors: McCarty Caitlin , Traeger Lara , Greer Joseph A. , Temel Jennifer S. , McDonnell Theresa Margaret 
Published: February 2017

176 Background: Side effects of curative chemotherapy regimens are highly prevalent and can lead to unplanned oncology clinic visits or hospital-level care. The current study aim was to examine physical symptoms among patients at their first chemotherapy visit, even prior to receiving their first infusion, in order to characterize symptom burden and unmet needs at this early stage of care. Methods: The current study utilized baseline data from a larger health services research trial for consecutive patients initiating chemotherapy for non-metastatic breast (48.0%), colorectal (28.0%), or lung (24.0%) cancer (n=75). Patients were invited to complete a self-report survey at their first chemotherapy visit, including demographics and measures of physical symptoms (Memorial Symptom Assessment Scale) and psychological distress (Patient Health Questionnaire-4; score ≥ 3 indicates positive anxiety or depression screen). Results: Among participants (M age=55.3 [SD=13.3]; female=70.7%), more than half (54.7%) endorsed at least one physical symptom -- primarily fatigue (34.7%) and constipation (29.3%). Additionally, one-fourth (25.3%) screened positive for anxiety (22.7%) and/or depression (9.3%). There were no differences in physical symptom bother or likelihood of fatigue or constipation, by factors including patient age, gender, marital status, work status, disease type, recent surgery, or concurrent radiotherapy. However, patients with positive anxiety and/or depression screens reported greater symptom bother and were more likely to endorse fatigue relative to those with negative screens (Mbother=4.5 vs. 1.3; fatigue=78.9% vs. 19.6%, p’s<.01). There was no difference in constipation between these groups. Conclusions: Symptom frequency was markedly high among patients initiating curative chemotherapy, with at least half reporting physical symptoms prior to their first infusion, and psychological distress clustered with general symptom bother and fatigue. Future work should explore 1) the extent to which physical and psychological symptoms at chemotherapy initiation may be associated with longitudinal symptom profiles, and 2) strategies for addressing symptom burden early on in outpatient care.
Association of high symptom burden with oral oncolytic agents.
Authors: Severson Jane Alcyne , Mackler Emily , Marini Bernard , Blayney Douglas W. 
Published: February 2017

177 Background: Increasing numbers of cancer patients are being treated with oral oncolytics. This change represents a shift from frequent direct observation during intravenous therapy to periodic observation and increased necessity for improved monitoring and self-care management. Despite this shift, patients are at risk to develop many of the same chemotherapy-associated symptoms and toxicities. We sought to understand the symptom burden associated with use of oral oncolytics. Methods: Michigan Oncology Quality Consortium (MOQC) sponsored a quality improvement initiative focused on improving oral oncolytic care. Eight oncology practices participated. Patients were assessed with a modified Edmonton Symptom Assessment System (ESAS) prior to each outpatient visit. A total of 537 surveys were analyzed. 13 measures were categorized into mild (0 to 3), moderate (4 to 6), and severe (7 to 10) symptom burden. Results: Overall, the average ESAS symptom score was mild in 81% of patients, moderate in 13% of patients, and severe in 6% of patients. These average scores, however, obscure the significant burden in select ESAS domains. For example, 39% of patients categorized their overall well-being as being moderate/severely affected; 38% of patients felt they were moderate/severely fatigued, and 21% indicated moderate/severe neuropathy symptoms. Notably, 118/537 (24%) of the assessments had 4 or more symptoms rated moderate to severe. Conclusions: Patients taking oral oncolytics experience significant symptom burden that impacts quality of life. Intolerance of oral oncolytics may lead to adherence issues, potentially affecting expected outcomes. Given the prevalence of symptoms and potential for toxicity, self-care strategies to improve early recognition and treatment of symptoms by patients taking oral oncolytics are necessary. [Table: see text]
The routine use of the Edmonton classification system for cancer pain in an outpatient supportive care center.
Authors: Arthur Joseph , Yennu Sriram , Nguyen Linh , Tanco Kimberson , Chisholm Gary B. , Hui David , Bruera Eduardo 
Published: February 2017

180 Background: There is no standardized and universally accepted pain classification system for the assessment and management of cancer pain in both clinical practice and in research studies. The Edmonton Classification System for Cancer Pain (ECS-CP) is an assessment tool that has demonstrated value in assessing pain characteristics and response. The purpose of the study was to determine the relationship between the negative ECS-CP features and some pain related variables like pain intensity and opioid use. Also, we explored whether the number of negative ECS-CP features was associated with higher pain intensity. Methods: Electronic charts of 100 patients at the outpatient supportive care clinic in a comprehensive cancer center were reviewed for patient characteristics, initial ECS-CP assessment, the morphine equivalent daily dose (MEDD), opioid rotation, the Edmonton Symptom Assessment Score (ESAS), Memorial Delirium Assessment Scale (MDAS), performance status, and the use of adjuvant analgesics. Results: Ninety one out of the 100 charts were therefore eligible for analysis. The median age was 58.4 years. The most common primary cancer site was gastrointestinal cancer (22.1%). The median pain intensity was 6 and the median MEDD was 45mg. Incident pain was the most common ECS-CP feature (60%) and cognitive dysfunction was the least frequent feature (2%). Neuropathic pain was associated with higher median pain intensity (7 vs. 5, p=0.007) and median MEDD requirement (83 vs. 30, p=0.013). Psychological distress was associated with higher median pain intensity (7 vs. 5, p=0.042). Incident pain was also associated with a trend for higher pain intensity (6 vs 5, p= 0.06). A higher number of negative ECS-CP features was associated with higher pain intensity (p=0.01). Conclusions: The ECS-CP was successfully completed in the majority of patients, demonstrating its utility in routine clinical practice. Neuropathic pain and psychological distress were associated with higher pain intensity. Also, neuropathic pain was associated with higher MEDD. A higher sum of negative ECS-CP features was associated with higher pain intensity. Further studies will be needed to explore this observation.
Effect of duloxetine on chemotherapy-induced painful peripheral neuropathy.
Authors: Hirayama Yasuo , Terui Takeshi , Koike Kazuhiko , Kusakabe Toshiro , Horiguthi Hiroto , Ishitani Kunihiko 
Published: February 2017

181 Background: Approximately 20% to 40% of patients with cancer who receive neurotoxic chemotherapy will develop painful chemotherapy-induced peripheral neuropathy. Smith et. al firstly reported that duloxetine was effective on above neuropathy after taxanes and platinums (JAMA 2013), so we planed to evaluate the duloxetine effect in Japanese patients after above drugs and more expanding drugs include vinca alkaloids and bortezomib. Methods: Patients were randomized to receive either duloxetine followed by vitamin(V)B12 or VB12 by duloxetine. The initial treatment consisted of 20 mg of duloxetine or 1.5g VB12 for the first week and 40mg of duloxetine or VB12 daily for 3 additional weeks (an open label, randomized, crossover). Dose reduction by the adverse effects was permitted. The primary hypothesis was that duloxetine would be more effective than VB12 in decreasing chemotherapy-induced peripheral neuropathic pain. Numbness and Pain severity were assessed weekly using visual analogue scale (VAS). This research was approved by the Research Ethics Committee of Higashi Sapporo Hospital and University Hospital Medical Information Network (UMIN) Center in Japan.Thirty-four cases (Breast cancer: taxanes 2, gastric cancer: taxane 5, colon cancer: oxaliplatin 6, Malignant lymphoma: vincristine 13, multiple myeloma: bortezomib 8) were made an entry in our institution. Five cases dropped out because of the adverse effect with sleepy and general malaise. Results: Obvious improvements of VAS scores of numbness and pain were observed in duloxetine group. Significant differences of delta VAS (pre VAS scale – 4 weeks VAS after drug administration) were observed between duloxetine group and VB12 group in the aspect of numbness (p=0.02) and pain (p=0.03). Conclusions: Among patients with painful chemotherapy-induced peripheral neuropathy, the use of duloxetine compared with VB12 for 4 weeks resulted in a reduction in numbness and pain, but there are many cases with drop out by the adverse effects. Clinical trial information: 000011554.
Palliative care needs: Symptom reporting during geriatric oncology evaluation.
Authors: Flannery Marie Anne , Pandya Chintan , Tejani Mohamedtaki Abdulaziz , Kamen Charles Stewart , Magnuson Allison , Dale William , Morrow Gary R. , Mohile Supriya Gupta 
Published: February 2017

184 Background: Although extensive descriptive work has been conducted on the symptom experience in cancer, relatively little is known about the specific palliative care needs for geriatric oncology populations. When all age groups are studied older individuals report less symptoms and the symptom experience of older cancer patients is minimized. Utilizing data collected from two geriatric oncology referral clinics the primary aim of this study was to identify geriatric oncology patients’ symptom reports, the number of symptoms experienced, and interference reported from symptoms. Methods: Patients referred to a geriatric oncology consult clinic were asked to complete the MD Anderson Symptom Inventory (MDASI) total of 13 items. In addition all patients underwent comprehensive geriatric assessment with a battery of tests. Results: 192 patients completed the symptom inventory with a median age of 81 years (range 65-95). 94% of patients reported at least one symptom, >45% reported experiencing 10 of the 13 symptoms (mean number of symptoms =5.7, SD= 3.7). Most frequently reported symptoms were in order: drowsiness, trouble remembering, dry mouth, disturbed sleep, pain, distress, decreased appetitive, dyspnea, and sadness. Severity ratings for individual symptoms M’s= 0.3-2.5, although the complete range of 0-10 was reported. 67% of patients reported that symptoms were interfering with their quality of life, general activity level and walking ability. Conclusions: In contrast to the myth that older cancer patients have minimal symptoms, at time of referral to a geriatric oncology consultation patients report on average experiencing six symptoms which interfere with their quality of life. There is an intersection between geriatric oncology and palliative care and these descriptive findings highlight the importance of systematic symptom assessment for older individuals with cancer to identify needed symptom relief strategies.
Thromboembolic events in French patients with breast and prostate cancer hospitalized in 2011 and 2012: Incidence and costs.
Authors: Scotte Florian , Borget Isabelle , Vainchtock Alexandre , Martelli Nicolas 
Published: February 2017

192 Background: Venous thromboembolic event (VTE) is a common complication for cancer patients, leading to hospitalizations that increase the burden of cancer management. We evaluated the incidence and costs of VTE-related hospitalizations for patients with breast or prostate cancer, two of the most frequent cancers in France. Methods: We used the French national hospital database (PMSI) to select new patients with BC or PC in 2010, who had at least one VTE-related hospitalization during the following two years. VTE-related stays and patients were identified using the disease-specific ICD-10 codes. Hospital costs were estimated from the healthcare system perspective and included care, treatments, accommodation/investment costs and medical/technical procedures, using the French official tariffs. Results: Among 107,916 new patients with BC or PC, 2,268 were hospitalized for a VTE, representing an overall of 2,814 admissions. VTE was classified as primary or related diagnosis (PD/RD) in 1,004 (36%) admissions. Among those PD/RD admissions, pulmonary embolism was the most frequent diagnosis as it led to 626 (62%) stays. Deep venous thrombosis was the second cause of hospitalization (248 admissions; 25% of PD/RD admissions). Re-hospitalisation for recurrence was frequent, as it occurred 546 cases (19.4%) of all VTE-related hospitalizations. For a patient who did not experience recurrence, the mean cost per patient was €3,302 and €3,611 for BC and PC patients respectively. But this amount was highly increased for patients with recurrent VTE, to €5,545 per BC patient and €5,692 per PC patient. Finally, VTE-related hospitalizations were responsible for an overall expenditure of €3.40 million over two years, including €335,000 due to recurrent events. Conclusions: In cancer patients, VTE-related hospitalizations remain frequent and induce an elevated cost. Adequate prophylaxis and management could be an efficient way to reduce the incidence of this common complication and its economic burden. [Table: see text]
Daily patient-reported assessment of pain, anxiety, or distress, problems or concerns, and need to see physician during 100 courses of radiation therapy.
Authors: Howell David D. , Wilson Colette M. , Moore William Andrew 
Published: February 2017

193 Background: Patients (pts) undergoing radiation therapy (RT) treatment (Rx) may have pain, anxiety or distress (AoD), or other problems at the time of initiation of RT. Pts may also develop or have an exacerbation of one or more problems during RT. While undergoing RT, pts are seen weekly by the treating physician (MD), and seen daily by the treating radiation therapy technologists (RTT). Pts can develop problems between weekly MD visits which may benefit from expedited interventions. A protocol was developed where pts would be asked four questions each treatment day by the RTT: 1) Are you having pain, and if so, how would you rate it on a scale of zero to 10? (PainQ) 2) Are you having anxiety or distress today? (ADQ) 3) Are you having new problems or concerns? (ProConQ) 4) Do you want to see the physician today? (CMDQ) This information was charted, and used in pt management. Methods: 100 consecutive pt charts were reviewed for demographics including gender, age, primary malignancy, region treated, number of Rx and radiation dose. Daily answers from the four question instrument were also reviewed for each pt course of RT. Results: Of the 100 pt, 56 were male. Disease distribution: Breast-22; Prostate-20; Head and Neck-20; Lung-13; Brain-7; Other-18. For the ADQ, 83 did not report anxiety or distress; 17 reported AoD on 1-2 occasions. For the ProConQ, 35 reported none, 34 reported yes on 1-2 occasions, 22 reported yes on 3-5 occasions, and 9 reported yes on >5 occasions. 29 reported yes on 2 days in a row, and 15 reported yes on 3 days in a row. For the PainQ, 31 reported no pain throughout their course of RT, with 22, 23, and 25 reporting pain of any magnitude for 1 to 5, 6 to10, and >10 days, respectively. 22 reported pain level > 6 on at least one occasion. For CMDQ, 26 pts did not request to see the MD greater than the usual weekly visit, 71 and 3 requested to see the MD an additional 1 to 5, and 6 to 10 times. Conclusions: A simple four question daily query of pts undergoing a course of RT is feasible, and may prompt the need for evaluation and interventions between scheduled MD visits. This may facilitate more expeditious interventions for Rx related toxicity and treatment-dependent or independent symptoms or needs.