bluuebunny/crossref_metadata_2025_split huggingface dataset:
Providers' concordance with survivorship clinical algorithms.
Authors: Zandstra Frances Ann , Palos Guadalupe R. , Russell Ludivine , Gilmore Katherine Ramsey , Flores Jacklyn J. , Ozeri Delrose , Rodriguez Maria Alma 
Published: February 2017

243 Background: The utility of algorithms to guide clinical practice related to long-term survivorship care is unclear. In 2012, lymphoma survivorship algorithms for Hodgkin’s and Large B-Cell were developed as part of an institutional clinical practice initiative to enhance survivors’ outcomes. Here we describe providers’ concordance with minimum standards recommended in the survivorship lymphoma algorithm. Methods: Concordance, the primary outcome, was defined as whether minimum recommendations, summarized in the lymphoma algorithms, were provided during a survivorship visit. Concordance was measured using a “yes/no” response format assessing whether a provider’s recommendations were consistent with algorithms’ minimum standards including: 1) physical examination, 2) laboratory and imaging testing, 3) cancer screening procedures, and 4) health promotion education. Data were abstracted from electronic medical records and Passports (summary care plans). Secondary outcomes were number of survivors seen and Passports issued. All data included in these analyses were de-identified. Results: 63 survivors were seen in the Lymphoma Survivorship Clinic from 05/01 to 09/30/2012 and all received Passports. A provider tailored the plan to each survivor’s needs and counseled the individual on disease surveillance, life-style changes, screening recommendations, and specific procedures to assess for recurrence/late treatment effects. Results indicated 100% of survivors received a physical exam, including cardiovascular screening. Similar rates were also achieved for CBC testing, chest X-rays, and counseling survivors on screening recommendations relevant to: breast, cervical, colorectal and prostate cancers. Other counseling rates included 97% for skin exam recommendations and 100% for maintaining adult vaccinations. Finally, providers’ concordance with assessment of survivors’ psychosocial distress was 100%. Conclusions: Based on concordance results, providers met the minimum recommendations listed in the lymphoma algorithms. Future research is needed to assess the impact of providers’ use of algorithms on survivors’ outcomes and feasibility of replicating concordance analyses in other clinical care settings.
Support services of head and neck cancer survivors at 3 months post-treatment.
Authors: Quispe Jean Marie , Martens Kellie , Geller Jessica , Raben David , Kilbourn Kristin 
Published: February 2017

244 Background: Support services offer a multi-disciplinary approach to improve quality of life (QOL) in head and neck cancer (HNC) survivors. This study assessed support services of HNC survivors treated at a University-based cancer center. Methods: HNC survivors (N=115) who completed three-month post-treatment self-report questionnaires were recruited from three radiation oncology clinics. Questionnaires assessed emotional and physical symptoms, QOL, and use and interest in support services. Symptoms were assessed individually on a 5-point Likert scale. Utilization and interest of support services were assessed with yes/no scales while helpfulness of utilization was assessed on a 5-point Likert scale. Spearman correlation analyses were conducted in SPSS v22. Results: Participants’ were mostly male (77%) and Caucasian (79%), with a mean age of 58.71 years (SD=11.05), and 36% had stage III/IV cancer. The majority of participants (93.7%) agreed they received adequate support, yet, interest in classes/education (7.8%), integrative medicine (7.0%) and support groups (6.1%) were endorsed. Surprisingly, interest in these support services was associated with lower ratings of total symptoms: classes/education (r = -.48), integrative medicine (r = -.41) and support groups (r = -.55). More than half of participants utilized at least one support service (67.83%) with the most frequent including: nutritionist/dietitian (55.7%), social worker/navigator (21.0%) and cancer information line (15.7%). Utilization of some services was associated with lower ratings of individual symptoms: social worker/navigator and problems swallowing (r = -.31), fatigue (r = -.27) and pain (r = -.24); and cancer information line and weight loss (r = -.30). Meanwhile, overall helpfulness of support services (M = 2.37, SD = 1.51) was rated between “somewhat” and “quite a bit” helpful. Conclusions: This study suggests a relationship between utilization and interest in support services and symptom ratings. Notably, those who report more physical and emotional symptoms may be less likely to report interest in support services. This may be due to an inability to access support services because of lack of transportation, poor social living conditions, etc.
A pilot study on an idiographic assessment of quality of life in patients enrolled in phase I clinical trials.
Authors: Hou June YiJuan , Kaur Gurpreet , Klobocista Merieme , Zechmeister Jenna R. , Kuo Dennis Yi-Shin , Rapkin Bruce D. , Goldberg Gary L. , Nevadunsky Nicole Suzanne 
Published: February 2017

250 Background: Patient centered quality of life (QOL) is pivotal in treatment decision making for poor prognoses and recurrent solid tumors. Data regarding the best methods of QOL assessment for patients receiving chemotherapy for high risk cancers and enrolled in Phase I trials are sparse. We therefore piloted a QOL assessment that incorporated a validated metric as well as a novel “idiographic” questionnaire. Methods: Twenty-five women with high risk gynecologic malignancies (defined as < 30% five year survival) and 10 patients enrolled in Phase I clinical trials were recruited after IRB approval was obtained. Patients’ answers to the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire 30 (QLQ-30) and “idiographic” QOL assessment were recorded and decoded. Raw scores of the QLQ-30 were standardized using linear transformation. Statistical analysis was performed using Mann-Whitney U and Chi-square testing with SPSS software. Results: Idiographic assessment resulted in 100 goal statements in 17 domains from patients in Phase I trials as compared to 260 goals in 20 domains from patients with high risk gynecologic malignancies. There were no differences in goal attainment or satisfaction with attainment between groups. There was a trend toward increased number of autonomy directed goals in the high risk group versus Phase I participants (23% vs. 11%, p=0.07) Median scores on functional (71 high risk vs. 84 Phase I) and global health status (58 high risk vs. 67 Phase I) scales were not different between the two groups. However, higher symptom burden was reported by the high risk group as compared to the median Phase I score (51 vs. 27, p<0.01) Conclusions: There is a complex relationship between treatment decision-making and QOL for patients diagnosed with poor prognoses cancers. Further research is needed to better define QOL indicators and the impact of treatment on patient centered QOL.
Early palliative care involvement for children with cancer.
Authors: Mahmood Laila , Dozier Ann , Dolan James , Casey Denise , Korones David Nathan 
Published: February 2017

26 Background: Although the overall survival of children with cancer exceeds 80%, these children experience significant physical, emotional, social and spiritual suffering. That suffering is even more profound for the 20% of children who succumb to their disease. We therefore conducted a prospective study to assess the feasibility and impact of early palliative care involvement for children with high risk malignancies. Objective: To determine if early palliative care involvement for high risk pediatric oncology patients is feasible, acceptable to patients, families and oncology teams, and helps with symptom management and communication. Methods: This was a prospective survey-based study. Children with cancer treated at University of Rochester were eligible to participate if they had a high risk malignancy, defined as (1) having a newly-diagnosed malignancy with an estimated overall survival of < 50%, (2) requiring hematopoietic stem cell transplantation (HSCT), and/or (3) any relapsed, recurrent or progressive cancer. Parents of these children or children >18YO were surveyed upon study entry, and 3 and 6 months later to assess the impact of early and ongoing pediatric palliative care involvement. Results: 20/25 eligible patients received a palliative care consultation at diagnosis; 16 families participated in the study. Six children had a newly diagnosed high risk malignancy, nine had recurrent disease and one child had a HSCT. Median age of the children was 5 years (0.1-20 year).The most frequent symptoms at the time of study entry were pain (75%), nausea/vomiting (69%), constipation (44%), and fatigue (44%). 75%, 73%, 43% and 43% reported successful treatment of pain, nausea/vomiting, constipation, and fatigue respectively. The proportion of children with each symptom decreased at 3 months except for fatigue. There was high satisfaction with the oncology and pediatric palliative care teams at baseline and 3 and 6 months. No families or oncologists declined an early palliative care consultation. Conclusions: Our results suggest that an early palliative care consultation is feasible for high risk children with cancer and that the palliative care team can work successfully with the primary oncology team to foster symptom control and communication.
Integration of oncology palliative care in a regional health care system.
Authors: Edelen Connie , Koesel Nicole 
Published: February 2017

34 Background: Early incorporation of palliative medicine in cancer care has been shown to be associated with improved symptom control, quality of life, and patient and family satisfaction however integration in the outpatient setting remains deficient nationwide. Regional healthcare systems carry the additional challenge of providing consistent quality care across a diverse geographic area. We performed a retrospective review of oncology palliative care utilization in a regional healthcare system following the implementation of a fully integrated model of palliative care. Methods: In 2012, Levine Cancer Institute (LCI) and Carolinas Palliative Care collaborated to establish palliative care access across its 12-site regional cancer center. This was a transition from a vendor service to a fully embedded clinic at multiple LCI locations. The new model offered full time outpatient multidisciplinary services in addition to an inpatient oncology palliative care consult service. Standardization of care and early integration were augmented by the creation of symptom management guidelines and tumor treatment pathways with built in recommendations for palliative/supportive care. Results: New oncology palliative care referrals increased from 150 annually to over 475 in the first 12 months. The top diagnoses were lung (16%), breast (11%), and head and neck cancer (7.2%) with pain and symptom management as the primary reason for consultation. Ten symptom management pathways have been published for regional utilization, enabling primary palliative care and serving as a trigger for palliative specialist consultation. A toolkit was created to identify operational needs, clinical tools, and staffing at each site. Conclusions: The growth of oncology palliative care utilization by 317% demonstrates the success of a fully embedded program. This multidisciplinary model is being standardized across regional sites to ensure access to primary and secondary palliative care. Additional clinic sites and the application of telemedicine for rural areas are in development. Future research is needed to document outcomes associated with palliative care integration across the cancer trajectory in a regional healthcare system.
Integrating early palliative care into cancer care: A qualitative analysis of implementation models, barriers, and strategies in community settings.
Authors: Padgett Lynne Slaughter , Davis Mary Helen , Tallen Colleen , Jdaydani Andrew , Carrigan Angela 
Published: February 2017

36 Background: There is a paucity of research providing evaluation of implementation strategies contributing to provision of high quality early palliative care. Data from the NCI Community Cancer Centers Program (NCCCP) offers insight into ways in which patients, providers, and systems negotiate the provision of early palliative care in the community setting. The purpose of this project was to test the implementation of early palliative care programs for patients diagnosed with a high lethality cancer in participating NCCCP centers. Methods: Thirteen of 21 NCCCP sites elected to participate. Data on project activities and progress was gathered quarterly between July 2012 and June 2014. Qualitative data were evaluated using inductive and deductive methods and models of care, barriers and strategies were identified. Results: Models of care described included group education visits for patients and caregivers, outpatient clinics, and electronic consultation referral triggers. Irrespective of the model of care, sites reported barriers at the patient, provider and system levels. Barriers included reluctance by both patients and providers to consider palliative care services due to the perception of "giving up," and inadequate staffing and clinic space were also cited as systemic barriers. Strategies for facilitating implementation included integrating palliative care staff into existing cancer center programs (e.g., multi-disciplinary clinics), electronic referrals, and utilizing navigation services, as well as a variety of programs targeted to increase oncologist "buy-in." Conclusions: These results provide guidance for both researchers and clinicians in designing future multi-level interventions to facilitate the delivery of early palliative care, and the importance of identifying and utilizing provider and system resources in program design, development and promotion. Provider buy-in is an essential factor, but patient and system resources are equally important components of a successful implementation strategy.
Association between early palliative care referrals, inpatient hospice utilization, and aggressiveness of end-of-life care: An investigation of cancer decedents in a cancer-designated hospital in Japan.
Authors: Amano Koji , Tatara Ryohei , Katayama Hirofumi , Uno Teruaki , Takagi Ibuki 
Published: February 2017

39 Background: Palliative care has a positive effect on many clinical outcomes, yet most referrals to palliative care have occurred late. End-of-life (EOL) cancer care has become increasingly aggressive. There have been no studies investigating the association between early palliative care referrals and aggressive EOL care in Japan. Methods: This study was designed to explore the association between early palliative care referrals, inpatient hospice utilization, and aggressiveness of EOL care by investigating cancer decedents. A retrospective cohort study in a cancer designated hospital in Japan. This study examined 266 consecutive cancer decedents. Inclusion criteria were as follows: (1) adults and (2) patients who died from cancer or causes related to cancer. Patients who died from causes unrelated to cancer were excluded. A total of 265 patients met the criteria. We explored the association between early referrals (>3 months before death) and inpatient hospice utilization and the relationship between the timing of referrals and aggressive EOL care measured by a composite score adapted from Earle et al. Results: Patients were divided into an early referral group (n=54) and a control group (n=211). The rate of inpatient hospice utilization was significantly higher in the early referral group (74% vs. 47%, P<0.001). While each of six indicators of aggressiveness of EOL care did not differ significantly, the composite score was significantly lower in the early referral group (1.91 ± 0.59 vs. 2.14 ± 0.78, P=0.040). Conclusions: Early palliative referrals were associated with more inpatient hospice utilization and less aggressive EOL care.
Palliative care screening tool: Does utilization promote early integration of palliative care for inpatient oncology patients?
Authors: Farnan Michelle , Smeltz Erica , Glod Susan , Parson Nancy , Kreher Margaret 
Published: February 2017

43 Background: Early integration of specialty Palliative Care (PC) in cancer patients improves quality of life and lowers medical costs. Engaging cancer patients early remains challenging. A checklist approach that evaluates type of malignancy, comorbidities, functional status, uncontrolled symptoms, readmission rates, and psychosocial/spiritual distress may prompt consultation to the PC team. We evaluated a palliative care screening tool’s (PCST) effect on promoting early PC consultation for oncology inpatients. Methods: A modified version of the Center to Advance Palliative Care screening tool was utilized by our hospital as part of the admission assessment. Registered nurses completed the PCST within 24 hours of admission for all adults. A PCST score of 3 or higher prompted staff to suggest a PC consult. A retrospective chart review of oncology patients who received a PC consult was performed to assess whether the screening tool score within 24 hours of admission impacted timing of a consult order. Effective tool utilization was considered to be a consult order within 36 hours of a high risk screen score. Results: From January through March 2014, 215 cancer patients screened with the PCST were found to have a score of 3 or higher. Seventy seven percent scored a 3 or higher, and PC consultation occurred in 16% of that patient cohort. Twenty three percent of PC consults occurred in patients scoring less than 3. The average number of days from admission to PC consult was 6 days. Conclusions: Using a PCST did not trigger PC consultation for inpatient cancer patients. Thirty four percent of the screened patients died during that admission, indicating a dramatic change in status from admission or ineffective prognostication, both barriers to early integration of PC. Our work suggests that a screening tool alone, even in a center with a well-embedded PC program, is not a sufficient means of effectively integrating PC into a patient’s hospital stay. Further work to identify patient characteristics that lead to consultation in both high and low risk patients is necessary.
Impact of palliative care clinic (PCC) referrals on pain control in genitourinary (GU) cancer patients: Retrospective analysis at Roswell Park Cancer Institute (RPCI).
Authors: Gupta Neha , Gandhi Shipra , Anwar Sidra , Wang Katy , Satchidanand Yashodhara 
Published: February 2017

57 Background: Many cancer patients (pts) with GU cancer suffer from uncontrolled pain, and may benefit from more focused palliative care. We assessed the frequency and impact of specialist PCC referrals on pain management of our GU Medical oncology clinic (GUMOC) pts. Methods: 239 consecutive pts were collected from a retrospective review of GUMOC records from 12/1/2013 to 2/28/2014. This group of pts was used to assess the frequency of PCC referral. Pts were divided into two arms- Arm A= GUMOC pts referred to PCC; Arm B: GUMOC pts not referred to PCC. To be able to detect a 15% between the two arms at 95% significance, 37 additional pts (who were already being seen at GUMOC) were collected from retrospective review of PCC records over 9/1/2013 to 2/28/2014. Total 276 pts were divided into Arm A (n=49), Arm B (n=227 pts). Data for baseline pain score and 4-week follow up pain scores were collected. A palliative care screening tool (retrieved from Center to Advance Palliative care [CAPC] website) was used to assign palliative care screening score (PCSS) to all study pts. Chi square test and T-test were used for statistical analysis. Results: Out of the 239 initially collected GUMOC pts, 5% were referred to PCC. 10% (n=24) had PCSS score of ≥ 4, and 33% pts with PCSS ≥ 4 were referred to PCC. Arm A had worse baseline symptoms, ECOG status and more advanced cancer stage. 4-week pain score follow up revealed significant improvement in Arm A -2.74 vs. Arm B -0.13 (p<0.01). Conclusions: GU cancer pts who are referred to PCC from medical oncology clinic have significant decrease in pain symptoms. Frequency of PCC consultation is still low in comprehensive cancer institutes, and not in congruence with the available palliative care screening tools criteria suggested by CAPC. Standardized tools should be developed to guide PCC referrals, and routine use of these tools will significantly help in pain control by seeking specialist palliative care.
Integration of specialist palliative care services into a multidisciplinary adolescent and young adult (AYA) oncology team.
Authors: Hughes Rachel Elizabeth , Thompson Kate 
Published: February 2017

64 Background: Palliative care is recommended alongside standard oncological care for patients with advanced cancer or high symptom burden (Smith TJ, Temin S, et al. American Society of Clinical Oncology provisional clinical opinion: the integration of palliative care into standard oncology care. Journal of Clinical Oncology. 2012;30(8)880-7.). AYA oncology patients are distinguished by several age-specific developmental and biopsychosocial factors, resulting in a unique impact profile (Wein S, Pery S, Zer A. Role of palliative care in adolescent and young adult oncology. J Clin Oncol. 2010;28:4819-4824). Methods: To examine the benefits of multidisciplinary AYA care, a palliative care fellow was incorporated into an existing AYA oncology team in Australia, for a 12 month period. This role facilitated assessment/management of symptoms, general health issues, treatment toxicity, end of life care and bereavement support. Results: Between 2012 and 2013, of 83 new patients were referred to the AYA oncology service, 27 (32.5%) were referred the palliative care fellow. Notably, 37% of patients referred were receiving curative intent treatment. 10 patients (37%) were referred at diagnosis for symptom management. Pain was the most frequent reason for referral (n=17 63%). A total of 7 patients (26%) were referred for advanced disease/terminal care. Conclusions: Evaluation demonstrates that onsite availability of palliative care services is acceptable, facilitates early referral and has encouraged collaborative, AYA multidisciplinary care. A significant additional finding has been recognition of the demand for symptom management of patients early in their cancer experience. Further development and evaluation of AYA specific palliative care is warranted.