bluuebunny/crossref_metadata_2025_split huggingface dataset:
Developing and piloting an electronic telephone triage application.
Authors: Ellis Peter G. , Carlisle Christine , Ford Colleen F. , Hartman Jan , Nikolajski Peggy , Reidmiller Carol , Rushford Justin S. , Stewart Leslie , Barry Amanda , Krebs Melinda 
Published: February 2017

68 Background: Telephone triage is a vital part of today’s oncology practice and is often not standardized and measured to allow for quality improvement. UPMC CancerCenter (UPMC) has 31 outpatient clinics and is in need of a tool to streamline the current telephone triage process. UPMC and Via Oncology collaborated to develop and pilot a prototype of an electronic telephone triage application. The key components of the prototype were defined as decision support, EHR integration, reporting and workflow management. Methods: A prototype application, Symptom Manager (SM), was developed and piloted with 4 nurses at 3 outpatient clinics. Front office staff registered inbound calls in SM, which populated a phone triage queue. The nurse was prompted to enter information about the call. Decision support materials were displayed for reference, including algorithms for symptom assessment, adjudication and treatment. The output was a structured summary of the encounter that was copied to the patient’s chart. From the queue, the nurse was prompted to make outbound calls for symptom reassessment. A feedback session with nurse users and institution leadership was held following the pilot. Results: A total of 235 inbound calls were captured in the application, of which 74 (31.5%) were symptom-related. Additional data fields collected during the pilot included symptom, adjudication, time elapsed for callback, and symptom status at follow up. The ability to extract and report on data of this type was viewed as valuable for quality and process improvement. The nurse users praised SM’s ease of use, but prototype performance issues shortened the pilot. When referencing the decision support materials, nurses felt more confident consulting providers and during independent decision-making. They indicated that the standardized documentation increased efficiency. Requests for future enhancements included deeper EHR integration and additional fields for data capture. Conclusions: This prototype fulfilled the defined key components of a tool of this type. SM is currently being refined and incorporated into the Via Portal, Via Oncology’s decision support software. An update on the software and additional data captured during the pilot will be provided at presentation.
Feasibility of a physician-extender approach to increase advance care planning uptake.
Authors: Siegel Scott D , Fanning Cynthia 
Published: February 2017

8 Background: Advanced care planning (ACP) for people with life-limiting cancer has been associated with improved patient quality of life and care more consistent with patient wishes. Nevertheless, even though approximately 70% of patients with a life-limiting illness will require the substituted judgment of a proxy, fewer than 25% of patients have documented goals of care. This poor uptake has been attributed to limits in physician time and ACP training. The current study evaluated the feasibility of utilizing a physician-extender trained in ACP best practices to overcome these barriers and improve ACP uptake. Methods: Patients who met criteria for a life-limiting cancer diagnosis were identified by support staff in Medical Oncology offices and the Emergency Department (ED) in a large North East community health care system. Pending physician approval, a Licensed Clinical Social Worker (LCSW) with training and experience in ACP was available to provide support and assistance to patients, which included but was not limited to ACP. The LCSW initially met patients in clinic and subsequently in whatever way was most convenient for the patient (at future appointments, by phone, inpatient, or at the patient’s home). The program was approved by the Medical Oncology section and the Emergency Department. Results: ACP uptake, calculated as the percentage of eligible patients who participated in the program, was 14.6% in the Medical Oncology practices (60/140) and 44.6% (41/92) in the ED. The difference in uptake between the two sites was significant, χ2(1, N = 502) = 41.88, p < .01, and was primarily the result of Medical Oncologists determining that ACP was not appropriate for a subset of eligible patients. Conclusions: The results of this feasibility evaluation suggest that limits in time and ACP training are not the primary barriers to ACP uptake in oncology. Instead, the type of physician and setting proved to be important correlates of uptake. We consider the implications of these findings and identify next steps to better understand the factors that influence physician participation in ACP.
Patient-reported distress in adults with myelodysplastic syndromes (MDS).
Authors: Troy Jesse D , deCastro Carlos , Pupa Mary Ruth , Samsa Greg P. , Abernethy Amy Pickar , LeBlanc Thomas William 
Published: February 2017

80 Background: MDS are hematopoietic malignancies that are incurable in most patients. The National Comprehensive Cancer Network (NCCN) defines distress as an unpleasant emotional experience associated with the psychosocial complications of cancer that may interfere with quality of life. Distress is not well described in MDS and may be useful to screen for palliative care needs. Methods: We conducted a retrospective review of distress in ambulatory adult MDS patients visiting our clinics from July 2013 to September 2015. We abstracted demographic, diagnostic, and comorbidity data from records along with the 10-point ordinal NCCN Distress Thermometer (DT) and its 39-item Problem List (PL). NCCN guidelines suggest DT scores ≥ 4 be evaluated for referral to psychosocial resources. Results: We included 119 patients (median age = 68, range = 30-88 years; 73.9% White; 67.2% male; 29.4% with prior cancer). Half were low-risk and 5 progressed to AML. Twenty-three (19.3%) had ≥ 1 hospitalization and 10.9% had > = 1 emergency department visit. Ten patients died; 1 was referred to counseling and 1 used hospice. Three others were referred to counseling and no patients had a palliative care consult. There were 366 DT (median distress = 1, range = 0-10) across 580 visits and 106 patients (median = 2 DT/patient, range = 1-16). Fifty-two patients had at least 1 DT ≥ 4 and 19 had 2 or more DT ≥ 4. With patients classified by their maximum DT (median = 3, interquartile range = 1-7) ever-use of therapy (hypomethylating agents/lenalidomide/growth factors/transfusions/chelation) was associated with greater maximum DT (median = 4, range = 0-10, N = 73) compared with no therapy (median = 2, range = 0-9, N = 33; P = 0.03, 2-sample Wilcoxon test). Ninety-five patients reported 1,335 problems during 22,846 person-days of follow-up (median = 4 problems/patient/visit, range = 1-23). The 5 most frequent problems were fatigue (176 times; 76 patients), pain (92 times; 44 patients), worry (77 times; 43 patients), sleep (75 times; 39 patients), and tingling hands/feet (68 times; 33 patients). Conclusions: MDS patients experience frequent and substantial distress yet referrals to counseling and use of palliative care are rare. These findings point to unmet palliative care needs in MDS.
Relationship between pain and depression among patients with cancer at a community teaching hospital.
Authors: Goldberg Uri , Safarpour Damoun , Aung Khin N. , Pasco Neil , Levron Benjamin , Fung Amy , Kalantary Atefah , Hernandez Mario , Cary Byron , Khillan Ratesh , Panigrahi Kalpana , Kalavar Madhumati R. 
Published: February 2017

81 Background: While depression is often under-diagnosed in the general population, the rate of under-diagnosis among patients with cancer may be far higher. The American Cancer Society reports that a quarter of all patients with cancer may suffer from depression. We seek to identify a link between pain and depression among patients with cancer which may signal an enhanced need both for the involvement of mental health services and for more effective pain management. Methods: This is an observational cross-sectional study evaluating depression among patients with cancer in an outpatient setting. From June of 2015 to January of 2016, 29 patients from our institution’s affiliated cancer clinics were interviewed by study staff members about their pain and various other cancer-related concerns. Subjects were also administered the depression screening tool Patient Health Questionnaire 9 (PHQ-9). Data was collected and analyzed using Spearman’s rho. Results: The inclusion criteria included a confirmed cancer diagnosis and willingness to participate in a clinical study. There were no exclusion criteria. Age ranged from 43 to 87 and women comprised 75% of participants. Of the 18 patients who complained of pain (62.1% of the total), 14 reported pain of at least 7 of 10 in severity (77.8%). Severity of pain was found to correlate positively with the questions of “Poor appetite or overeating” as well as “Moving or speaking so slowly...Or the opposite — being so fidgety or restless...” (R = 0.41, P = 0.03; R = 0.40, P = 0.03, respectively). Presence of pain likewise correlated positively with the latter question (R = 0.46, P = 0.01). Conclusions: The effects of depression on patients with cancer may contribute to life-shortening complications related to reduced compliance with treatment and lifestyle modifications, as well as the exacerbation of heart disease and other comorbid conditions. Our findings demonstrate that pain, particularly severe pain, may signal an elevated risk of depression and call for the swift involvement of mental health services. Likewise, the high proportion of patients complaining of pain in general and severe pain in particular suggests a need for more aggressive pain management among patients with cancer within our cohort.
Integrative oncology consultation and symptom palliation: Analysis of patient-reported outcomes at a comprehensive cancer center.
Authors: Lopez Gabriel , McQuade Jennifer Leigh , Lee Richard T. , Williams Jane , Spelman Amy , Fellman Bryan , Li Yisheng , Bruera Eduardo , Cohen Lorenzo 
Published: February 2017

84 Background: Patients (pts) receiving cancer care are increasingly interested in complementary health approaches to improve symptoms and quality of life. We report on demographics and patient reported outcomes in an integrative oncology (IO) clinic. Methods: Pts presenting for IO consultation or follow-up completed: Measure Yourself Concerns and Wellbeing (MYCaW), Edmonton Symptom Assessment Scale (ESAS), Short Form 12 (SF-12) quality of life (QOL) scale, and an overall satisfaction questionnaire. Consultations were provided by medical oncologists. Results: 2,474 consultations were conducted from 9/2009 to 12/2013; 26.0% (n = 643) had ≥ 1 follow-up visit (mean 3.2; SD1.8). Most were female (69%) and white (75%); most frequent cancer types was breast (29%); 29% of pts had advanced disease. At baseline, ESAS scores were highest for Sleep (4.2; SD 2.8), Fatigue (4.0; SD 2.8), Well-Being (3.8 SD 2.6) and Anxiety (3.1; SD 2.9). Those with advanced disease had significantly higher baseline ESAS scores for pain, nausea, shortness of breath, and appetite; higher ESAS subscale scores for physical and global distress; lower SF-12 physical health scores; and were more interested in developing an integrative/holistic approach and appetite. Those with loco-regional disease were more interested in overall health, hot flashes, and dry mouth. For ESAS baseline scores ≥ 4 and follow up within 30 days of the initial consult, we observed overall improvement in ESAS symptoms (38-60% of pts with ESAS decrease ≥ 1). Overall satisfaction was high at both initial encounter (9.4; SD 1.3) and first follow up (9.5; SD 1.2). Patients were satisfied to very satisfied with how well MYCaW concern 1 and 2 were addressed: 8.0 (SD 2.2) and 9.1 (SD 1.8). No difference in overall satisfaction was observed comparing those with advanced vs loco-regional disease. Conclusions: Most pts presenting for integrative oncology consultation have early stage disease, relatively low symptom burden, and are most interested in support for overall health. Patients were overall very satisfied with how well their top concerns were addressed, with significant improvements in symptom distress.
Are patients with cancer concerned about burdening their families?
Authors: Kaur Sukhi , Choi Kelly , Pe Benito Ruth , DeVincenzo Victoria , Sassano Emily , Gruman Brooke , DeMarco Katherine , Contreras Jose , Tanenbaum Kathryn , Covington Jennifer , Paramanathan Dhakshila , Goldberg Stuart L. 
Published: February 2017

86 Background: A diagnosis of advanced cancer frequently thrusts family members into the role of caregiver. Although caregiver burdens have been well documented, less is known about the level of concern borne by the patient (pt) with cancer in placing a family member in this role, known as self-perceived burden (SPB). Methods: As part of the larger “Living with Cancer” project we prospectively surveyed 1307 pts with advanced malignancies receiving treatment with non-curative intent at 17 New Jersey cancer programs within the Regional Cancer Care Associates network between Sept 2015 and Apr 2016. Pts were asked one question about SPB on family members (5-level Likert scale). Results: Pts felt that “Living with Cancer burdens my family” all day every day 68 pts (5%), part of each day 109 pts (8%), most days 136 pts (10%), occasionally 571 pts (44%) or not at all 423 pts (32%). Twenty-four percent of responses were flagged as concerned (rated most days or greater by 313 pts). In a logistic regression model, SPB was correlated with marital status (married and divorced more concerned than single) and younger age (both p < 0.05). Patients living in lower median income neighborhoods also appeared to have a higher frequency of concern (p < 0.1) Factors not correlating with the level of SPB included gender, race, solid vs liquid tumor type, and length of cancer diagnosis. SPB was also not influenced by DNR status, having developed a Living Will, or documentation of power of attorney. Distance from the pt’s home to the cancer center was not associated with SPB on the caregiver. For comparison, on the same LWC project 38% of pts with advanced cancer were concerned about the financial toxicity of their care and 33% were concerned about pain (both p < 0.01 compared to SPB). Conclusions: Self-perceived burden on a caregiver was identified in 24% of pts with advanced cancer, less than those concerned about financial toxicity or pain, in this NJ series. Divorced/married pts and younger pts with cancer are more likely to express concern. Developing an EOLC plan (DNR/Living will/POA) does not appear to influence SPB concerns.
Earlier access to palliative medicine: An experience of integration into a community oncology practice.
Authors: Burcham Sandra , Matthews Jacqueline 
Published: February 2017

92 Background: A growing body of evidence supports the integration of palliative care as a standard for comprehensive cancer care. Through our experience as an inpatient palliative care provider, with 50% of our population having advanced cancer, we recognized the value proposition to provide continuity in the outpatient setting. Innovative Care Solutions developed a partnership with a large, community oncology program late 2015 for a palliative care multidisciplinary team to be embedded into one location of their practice. Methods: A full-time palliative licensed independent social worker (LISW) was dedicated to educate and engage screening process development. Utilizing the NCCN Distress Thermometer, referrals for care provision were then directed by the LISW to the most appropriate palliative care provider. The LISW addressed communication, goals of care discussions and advance directives. Identification of symptoms, including high level distress or mental health needs, were scheduled to see the palliative physician or advanced practice nurse, available two half days per week within the cancer center. Results: In the first quarter of service, the LISW screened a total of 85 patients, with 54 requiring PC interventions. Complex symptom needs were identified in seventeen percent, thirty percent were seen for psychosocial needs, and twenty percent were seen for completion of an advance directive. Thirty-six percent were seen for medical decision making. Conclusions: Integrating palliative care services in a community-based oncology practice has realized numerous positive patient outcomes and opportunities for further design. Using an evidenced based screening tool, identification of needs in an early access model appear to enable the patient to improve adherence to the medical plan care and avoid ER utilization. Symptom management has shown improved quality of life scores and PPS, and patient’s seen for psychosocial needs are able to explore aspects of person, as opposed to illness, that has improved overall well-being. Further program design will focus on integration of screening for all patients with advanced solid tumor, recurrent/refractory, and formalization of quality data tracking benchmarked to a web-based registry.
Frequency, predictors, and outcomes of urine drug test among patients with advanced cancer on chronic opioid therapy at an outpatient supportive care clinic.
Authors: Arthur Joseph Anthony , Edwards Tonya , Hui David , Waletich-Flemming Jessica Marie , Reddy Suresh K. , Liu Diane D , Wu Jimin , Bruera Eduardo 
Published: February 2017

94 Background: Data on the utilization and outcomes of urine drug tests (UDT) among advanced cancer patients is limited. The main objective of this study was to determine the factors associated with UDT ordering and results in advanced cancer outpatients. Methods: A retrospective chart review of 1058 patients seen from March 2014 to November 2015 at an outpatient supportive care clinic was conducted. Sixty-one patients on chronic opioid therapy who underwent UDT were identified. A control group of 120 patients who did not undergo UDT was selected for comparison of information on demographic and clinical characteristics. Results: 61/1058 patients (6%) underwent UDT. 33/61 patients (54%) had abnormal results. Multivariate analysis found that the odds ratio for UDT ordering was 3.9 in CAGE positive patients (p = 0.002), 4.41 in patients less than 45years (p < 0.001), 5.58 in patients with moderate to severe pain (ESAS pain score ≥ 4) (p < 0.001), 0.27 in patients with advanced cancer stage, (p = 0.008), and 0.25 in patients with moderate to severe fatigue (p = 0.001). Among 52 abnormal UDT results in 33 patients, the most common opioid findings were: prescribed opioids absent in urine (14/52, 27%) and un-prescribed opioids in urine (13/52, 25%). Conclusions: UDT was used infrequently among advanced cancer patients receiving outpatient chronic opioid therapy. Younger age, CAGE positivity, early cancer stage or NED status, higher pain intensity, and lower fatigue were significant predictors of UDT ordering. More than 50% of UDTs were abnormal. More research is necessary to better characterize aberrant opioid use in advanced cancer patients.
A 17-gene genomic prostate score (GPS) as a predictor of biochemical (BCR) and clinical recurrence (CR) in men with surgically treated intermediate- and high-risk prostate cancer (PCa).
Authors: Klein Eric A. , Zhang Nan , Crager Michael , Maddala Tara , Febbo Phillip G. , Thomas Shibu , Gormley Michael , Ricci Deborah Sokol , Falzarano Sara Moscovita , Magi-Galluzzi Cristina , Lawrence H. Jeffrey 
Published: February 2017

104 Background: The biopsy-based GPS (scale 0-100) is validated as an independent predictor of adverse pathology in men with low- and intermediate-risk PCa. We wished to examine the association of GPS with BCR and CR in higher-risk disease. Methods: We performed exploratory analyses of data from a prior development study of radical prostatectomies from 441 men with AUA low-, intermediate- and high-risk disease, using a cohort sampling design (Klein et al. Eur Urol 2015). Multivariable Cox proportional hazards models were employed with the cohort sampling weights. Since these data were used in the selection of genes and coefficients for GPS, hazard ratios (HR) and other estimates based on GPS were corrected for regression to the mean (RM), and Storey’s method was applied to hypothesis tests for GPS to control the false discovery rate (FDR). Results: All estimates are RM-corrected. Broad, overlapping ranges of GPS values were observed across all AUA risk groups. GPS was strongly associated with BCR (HR 1.64 for 20 GPS units, p<0.001, FDR q-value < 0.1%) and CR (HR 2.79 for 20 GPS units, p < 0.001; FDR q-value < 0.1%), after adjusting for AUA risk group. Intermediate-risk patients with GPS > 40, who represented 41% of all intermediate-risk patients, had estimated 3-year BCR risk and 10-year CR risk similar to high-risk patients (Table). Conversely, high-risk patients with GPS≤ 40, who represented 63% of all high-risk patients, had a 3-year BCR risk and a 10-year CR risk similar to men with intermediate-risk disease. High-risk patients with GPS > 40 had 3-year BCR risk of almost 50% and 10-year CR risk of 35%. Conclusions: GPS appears to provide improved risk stratification for BCR and CR in AUA intermediate- and high-risk PCa. These findings require confirmation in an independent cohort of patients. [Table: see text]
Toxicity in a multimodality approach of radical prostatectomy with radiation and hormonal therapy.
Authors: Loeb Stacy , Adam Meike , Tennstedt Pierre , Huber Wolfgang , Bernard Juergen , Tilki Derya , Graefen Markus , Huland Hartwig , Schlomm Thorsten 
Published: February 2017

107 Background: While the optimal use and timing of secondary therapy after radical prostatectomy remain controversial, there are limited data on the patient-reported outcomes following multimodality therapy. Our objective was to assess the impact of additional radiation and/or hormonal therapy on long-term urinary continence, quality of life and potency after radical prostatectomy. Methods: Among 13150 men treated by radical prostatectomy (RP) from 1992-2013, 905 underwent secondary radiation therapy (RP+RT), 407 received androgen deprivation therapy (RP+ADT) and 688 a combination of RT and ADT (RP+RT+ADT). Urinary function, sexual function and quality of life were evaluated annually using self-administrated validated questionnaires. Urinary function was assessed by the use of the number of pads in 24h (analyzed as 0 pads, safety only, 1-2, or ≥ 3 pads). Potency was defined as ≥ 3 points out of 5 on the question whether erections were hard enough for penetration. Quality of life was assessed using a score from 0-100%.The distribution of urinary function, sexual function and quality of life were plotted as a function of time after bootstrap analysis (n = 1000) of a propensity score matched cohort. Results: Urinary function. The distribution of 0 pads and 1 safety pad between patients with a) RP and RP+RT was 72.3% vs. 67.9% and 16.7% vs. 18.6%; b) between RP and RP+HT was 64.5% vs. 55.5% and 16.1% vs. 21.9%; c) between RP and RP+RT+ADT was 67.4% vs. 54.8% and 17.7% vs. 21.8% and d) between RP+RT and RP+RT+ADT was 64.5% vs. 55.5% and 16.1% vs. 21.9%. Potency. The distribution of potency between patients with a) RP and RP+RT was 62.9% vs. 40.0%; b) between RP and RP+HT was 59.1% vs. 29.3%; c) between RP and RP+RT+ADT was 57.4% vs. 24.0% and d) between RP+RT and RP+RT+ADT was 44.2% vs. 32.1%. Quality of life. The distribution of a score of 83.3%-100% between patients with a) RP and RP+RT was 67.9% vs. 57.4%; b) between RP and RP+HT was 57.8% vs. 41.7%; c) between RP and RP+RT+ADT was 59.3% vs. 48.2% and d) between RP+RT and RP+RT+ADT was 60.0% vs. 41.2%. Conclusions: Secondary therapy after radical prostatectomy has a negative influence on urinary function, potency and quality of life.