bluuebunny/crossref_metadata_2025_split huggingface dataset:
Can pelvic lymph node dissection be omitted in intermediate-risk prostate cancer patients? A SEER-based comparative study using inverse-probability-of-treatment weighting.
Authors: Chen Yu-Wei , Mahal Brandon Arvin Virgil , Ziehr David R. , Nezolosky Michelle Daniel , Viswanathan Vidya Bhavani , Choueiri Toni K. , Trinh Quoc-Dien , Nguyen Paul Linh 
Published: February 2017

95 Background: To investigate whether pelvic lymph node dissection (PLND) reduces prostate cancer specific mortality (PCSM) in surgically-treated men with intermediate-risk prostate cancer (Pca). Methods: We identified 44,112 men diagnosed with intermediate-risk Pca from 2004-2009 in Surveillance, Epidemiology and End Results Program (SEER). We used inverse-probability-of-treatment weighting (IPTW) to adjust for baseline characteristics between PLND + radical prostatectomy (RP, N=26,571), versus RP alone (N=17,541) groups; Cox competing-risk model and propensity score-adjusted analyses were used for validation. Gleason scores were based on prostatectomy since biopsy scores were not available for RP-treated patients in SEER from 2004-2009. Results: After a median follow-up of 54 months, there was no survival benefit associated with PLND + RP compared to RP alone (Gray's test, P=0.30). After IPTW adjustment for baseline characteristics, PLND was still not associated with PCSM (AHR: 0.93, 95% CI: 0.65-1.33). This result was consistent with propensity score-adjusted model (AHR=1.05, 95% CI: 0.71-1.55) and the Cox competing-risk model (AHR=1.06, 95% CI: 0.71-1.57). Of men who received RP with PLND, 502 men (1.9%) had pathologically positive lymph nodes, which were associated with a higher risk for PCSM (AHR: 4.02, 95%CI: 1.83-8.84). Conclusions: PLND with RP was not associated with reduced PCSM compared with RP alone in men with intermediate-risk disease, suggesting that PLND is diagnostic but not therapeutic in this patient population. However, a caveat of this study is that risk group was defined by pathologic Gleason score; the 5% of clinically intermediate risk patients who are typically found to have Gleason 8-10 disease at prostatectomy could not be included in this analysis. [Table: see text]
The impact of HistoScannin in prostate cancer detection: A sextant-specific analysis of detection and on tumor volume.
Authors: Porres Daniel , Pfister David J. K. P. , Kuru Timur H. , Heidenreich Axel 
Published: February 2017

96 Background: In the search of optimized screening for prostate cancer (PCa), HistoScanning (HS) has been introduced to support detection and assessment of cancer foci. The aim of our study was the evaluation of the impact of HS in the diagnosis of prostate cancer by a comparison with the histopathological results after prostatectomy. Methods: 282 patients between 37 and 75 years with histologically confirmed, organ-confined PCa that were scheduled for radical prostatectomy underwent transrectal ultrasound prior to surgery. HS was evaluated compared to histology that was performed on removed prostates as to: 1) prediction of overall tumor volume and 2) accuracy of HS in detection of PCa lesions bigger than 0.2 or 0.5 ml, respectively, separated for each sextant. Results: HS tends to underestimate volume of cancerous lesions, particularly larger lesions > 8 ml. Using a 0.2 ml detection threshold, specificity and sensitivity of HS was between 29%-68% and 46-78%, depending on the sextant. For a 0.5 ml detection threshold, sextant-specific specificity increased to 59-92% and sensitivity decreased to 16-54%. Stratification according to pre-operational PSA-values did not improve performance characteristics of HS. Separate analysis of data from low grade tumor after d’Amico criteria showed that HS is not able to reliably detect these tumors. Conclusions: Overall, our study does not support a significant contribution of HS to PCa diagnostics.
Rehospitalization of advanced cancer patients in the year after diagnosis.
Authors: Whitney Robin L. , Bell Janice , Tancredi Daniel J , Romano Patrick S. , Bold Richard J. , Joseph Jill G. 
Published: February 2017

10 Background: Among individuals with advanced cancer (AC), frequent hospitalization is often at odds with patient preference and is increasingly viewed as a hallmark of poor quality care. Hospitalization contributes substantially to costs and regional spending variation in this population, but patterns and reasons are poorly described in the literature. Methods: California Cancer Registry data linked with hospital claims were used to quantify hospitalization in the year after diagnosis among individuals with AC [colorectal, pancreatic, prostate, breast, non-small cell lung cancer (NSCLC)] between 2009-2012 (n = 25, 032). Multi-state models and multilevel log-linear Poisson regression were used to model re-hospitalizations as a function of individual and hospital characteristics, accounting for the competing risk of mortality. Results: Among individuals with AC, 71% were hospitalized, 16% had at least 3 hospitalizations, and 64% of hospitalizations originated in the emergency department. Re-hospitalization rates were significantly higher for black, non-Hispanic (IRR 1.3; 95% CI: 1.1-1.4); Hispanic (IRR 1.1; 95% CI: 1.0-1.2); or Asian/Pacific Islander (IRR 1.1; 95% CI: 1.0-1.2) race/ethnicity vs. white, non-Hispanic; for public (IRR 1.4; 95% CI: 1.3-1.5) or no insurance (IRR 1.2; 95% CI: 1.0-1.5) vs. private; for lower SES quintiles (IRRs 1.1-1.3) vs. the highest; for 1 and 2 or more (IRR 1.1-1.6) comorbidities versus none, and for pancreatic cancer (IRR 2.1; 95% CI 1.9-2.2) and NSCLC (IRR 1.7; 95% CI 1.5-1.9) vs. colorectal cancer. Re-hospitalization rates were significantly lower after discharge from a hospital reporting an outpatient palliative care program (IRR 0.90; 95% CI 0.84-0.96). Conclusions: Individuals with AC experience a heavy burden of hospitalizations, many of which originate in the ED. Discharge from a hospital reporting an outpatient palliative care program appears to protect against re-hospitalization. Efforts to reduce hospitalization and provide care congruent with patient preferences might focus on improving access to outpatient palliative care, particularly among subgroups at greater risk, including racial/ethnic minority groups, those with lower SES, comorbidities and pancreatic or NSCLC.
Attitudes of radiation oncologists toward palliative and supportive care in the United States: Report on National Membership Survey by the American Society for Radiation Oncology (ASTRO).
Authors: Wei Randy , Yu James B. , Mattes Malcolm , Thrasher Adrienne , Shu Hui-Kuo George , De Los Santos Jennifer F. , Paganetti Harald , Koontz Bridget F. , Abraham Christopher , Balboni Tracy A. 
Published: February 2017

105 Background: Radiation oncologists are frequently involved in providing palliative and supportive care (PSC) for patients with advanced cancers through delivery of palliative radiation. Whether they are confident in their ability to assess and initiate treatments for pain, non-pain, and psychosocial distress is unknown. The American Society for Radiation Oncology (ASTRO) surveyed its practicing members in the United States on self-assessment of their primary PSC skills, and access to continuing medical education on PSC. Methods: We electronically surveyed 4,093 practicing radiation oncologists in the United States. The survey consisted of 17-questions in five sections: demographics, PSC training, domains of PSC, perceived barriers as a radiation oncologist to initiate advanced care planning, and discussion on prognosis. Results: The majority (91%) of radiation oncologists surveyed believe PSC is an important competency for radiation oncologists. Most radiation oncologists reported that they are moderately confident in their ability to assess and manage pain and GI symptoms but less confident in their ability to manage anorexia, anxiety, and depression. Despite areas of decreased confidence, a large number (42%) of radiation oncologists do not receive any additional PSC education beyond their residency training. Lastly, a perceived fear of upsetting referring medical oncologists and lack of clinic time are concerns for radiation oncologists who may want to initiate goals of care/advance care planning discussions with patients and their families. Conclusions: Radiation oncologists are more confident in their ability to assess and manage pain than in their ability to manage depression, anxiety, anorexia, and fatigue. There is a need for increasing continuing medical educational efforts in PSC for practicing radiation oncologists, and strengthening PSC training in residency programs.
Referral practices of medical oncologists to palliative care for patients with metastatic non-small cell lung cancer (NSCLC).
Authors: Feld Emily , Horn Leora , Phillips Sharon E. 
Published: February 2017

108 Background: Early implementation of palliative care has shown to improve quality of life and prolong survival in pts with metastatic NSCLC. We sought to investigate the attitudes and referral practices among medical oncologists treating pts with metastatic NSCLC. Methods: Participants were identified through the IASLC 2015 membership directory. All participants were contacted via email to complete an 18-question online survey that included demographic variables as well as questions on referral practice and attitudes regarding the role of palliative care in the treatment of metastatic NSCLC pts. Results: The response rate was 31% (93/303). The majority of participants (94%) practice in an academic setting and 57% had no prior palliative care training. 88% of oncologists report easy access to palliative care providers and 94% have an affiliated palliative care practice within their institution. 83% believe there is definitive evidence in the literature supporting the benefit of early palliative care; however, 40% feel this evidence supports only improved quality of life, not prolonged survival. 58% of oncologists agree that metastatic NSCLC pts should be referred to palliative care early in their disease course. In practice, however, they refer 19% of pts to palliative care at the time of first treatment initiation and this only increases to 38% when considering all referrals made when pts are actively receiving chemotherapy. Reasons for not referring pts include lack of symptoms (56%), belief that oncologists can manage palliative care needs independently (46%), not wanting to burden pts with appointments (41%), concern that referral may not be well received by pts (38%), and long wait times (20%). Reasons for referral include inadequately managed pain (97%), no further treatment options (70%), weak support network (71%), depression/anxiety (68%), other cancer-related symptoms (69%), dwindling treatment options (66%), and lack of time to address palliative care needs (58%). Conclusions: While most oncologists acknowledge the benefit of early palliative care consultation for metastatic NSCLC pts, a minority of pts are referred and strategies to improve referrals are needed.
Organizational factors influencing specialty palliative care utilization at academic cancer centers.
Authors: Schenker Yael , Rabow Michael W. , Crowley-Makota Megan , Waters Mallory Marie , Nkumsah Michelle , White Douglas B , Chu Edward , Smith Cardinale B. , Arnold Robert 
Published: February 2017

109 Background: Rates of early specialty palliative care utilization remain low, despite increasing familiarity and favorable attitudes amongst cancer center oncologists. In this context, understanding organizational barriers to specialty palliative care use becomes critical. Methods: We conducted a qualitative interview study with 74 medical oncologists practicing at 3 U.S. academic cancer centers with well-established specialty palliative care clinics. The in-depth interview guide elicited experiences and views related to outpatient palliative care. For this analysis, we focused on organizational factors influencing palliative care use, defined as the structural arrangements and social patterns that facilitate or impede implementation of best practices in healthcare. The team conducted mixed deductive and inductive coding, using Cabana’s quality improvement framework as a starting point. Key concepts were iteratively refined with interdisciplinary input. Two coders applied the final codebook to all transcripts, with disagreements reviewed and resolved by team consensus. Results: Participating oncologists were 68% male, specialized in solid tumors (61%), hematologic malignancies (32%), or both (7%), and had been practicing oncology for a mean of 17 (SD 12) years. Organizational factors impeding early specialty palliative care utilization included: the perceived burden on patients from spending more time at clinic appointments, which was balanced against the value added from specialty palliative care; social, financial, and disease-related factors interfering with patients’ ability to attend additional specialty visits; the clinic name, with concern that patients equated ‘palliative care’ with death, dying or giving up; an unwieldy referral process without availability of same-day appointments; and inadequate communication between oncologists and palliative care specialists. Conclusions: Even when oncologists are aware of the evidence and agree with recommended practices, organizational factors may impede adherence to oncologic and palliative care guidelines. Addressing these barriers could improve use of outpatient specialty palliative care.
Referral patterns to palliative care: An inpatient snapshot study.
Authors: Wong Aaron Kee Yee 
Published: February 2017

119 Background: Research suggests that palliative care referrals are not done as often or as early as required. In order to address potential barriers to referrals, current referral patterns need to be explored. We sought to identify the adequacy of palliative care referrals in hospital. Methods: We undertook a retrospective, cross-sectional study, censoring all inpatients on a single day from the largest tertiary hospital in the state. Each file was reviewed, and patients were identified as “palliative” based on the Gold Standards Framework criteria. Patients were followed for 3 months or until discharge, whichever was earlier. Results: Of the 873 inpatients, 134 patients were identified as palliative. Of the 95 patients who required formal palliative care input, only 28% were referred (27 patients). Specialty medical teams were the best at referring, whereas surgical teams were the worst. Only 50% of patients requiring terminal care and 10% requiring community palliative care (CPC) were referred. Conclusions: Alarmingly, most patients requiring palliative care were not referred (72% unreferred), most of these requiring CPC. Excluding CPC, still only 58% of patients requiring palliative care were referred. This is concerning, given data that shows that early integration of palliative care provides better quality of life, reduced depressive symptoms, and longer median survival. This suggests that either the severity of their illness is not recognised by treating teams, or that there is a lack of awareness in CPC, or possibly a lack of confidence in discussing it. There is a need for better referrals to palliative care, especially to CPC. Greater education is required, targeting the importance of early referrals. As used in this study, the Gold Standards Framework criteria can help identify patients who require referrals.
Variation in utilization of palliative surgery in patients with metastatic colorectal cancer.
Authors: Healy Mark Andrew , Nathan Hari , Regenbogen Scott E. , Hendren Samantha , Morris Arden M. , Suwanabol Pasithorn Amy 
Published: February 2017

120 Background: Twenty-five percent of patients with colorectal cancer will present with unresectable disease. Palliative surgery has been shown to improve symptom control and improve patient satisfaction as well as demonstrate improved cost and decreased healthcare utilization. However, it is unclear what factors influence use. We sought to determine patient and hospital factors associated with palliative surgery use in advanced colorectal cancers. Methods: Using the National Cancer Data Base (NCDB) Participant User File from 2006 to 2012, 162,967 patients with metastatic colorectal cancer were identified. Hierarchical regression was used to evaluate patient factors associated with use of palliative surgery. Hospitals were then categorized into quintiles based on palliative surgery utilization. Results: On multivariable analysis, factors associated with palliative surgery included rectal tumor site (OR 1.63, 95% CI 1.49 – 1.77), Asian/Pacific islander race, Medicaid/uninsured status, and longer duration from diagnosis to treatment (p < 0.05 for all). After stratifying hospitals into quintiles of utilization, significant regional variation in use of palliative surgery was noted. The lowest likelihood of use of palliative surgery was the NCDB South Atlantic region (DC, DE, FL, GA, MD, NC, SC, VA, WV). Compared to this region, hospitals with high use of palliative surgery were more common in the Pacific (OR 2.08, 95% CI 1.9-2.26), West South Central (OR 2.60, 95% CI 2.39 – 2.84), East North Central (OR 4.15, 95% CI 3.86 – 4.46), Mountain (OR 4.72, 95% CI 4.22 – 5.27), West North Central (OR 5.30, 95% CI 4.83 – 5.83), East South Central (OR 5.42, 95% CI 4.97 – 5.92), Middle Atlantic (OR 6.75, 95% CI 6.24 – 7.30), and New England (OR 6.75, 95% CI 6.05 – 7.54) regions. Compared to community cancer centers, high utilization hospitals were more likely to be academic/research centers or comprehensive cancer centers. Conclusions: In metastatic colorectal cancer, race and socioeconomic status appear to play a role in use of palliative surgery. It appears that use is higher for patients at academic/research hospitals or comprehensive cancer centers. Significant regional variation also exists in use of palliative surgery.
Identifying barriers to oncologist referral to palliative care: A dual approach.
Authors: Whelan Kyle 
Published: February 2017

121 Background: Longitudinal palliative care has demonstrated benefits for cancer patients, and the American Society for Clinical Oncology recommends that palliative care be used along with standard anti-cancer therapy at the diagnosis of serious disease. However, studies have shown that oncologists still often refer to palliative care within days of the end of life, or not at all. This indicates that oncologists face barriers, systems-based or self-imposed, to palliative care referral. This study aims to identify specific barriers that prevent oncologists from referring cancer patients to palliative care services. Methods: Barriers to referral were identified via a dual approach. A literature review was performed using a PubMed search of articles published since 2012, when the ASCO provisional opinion was issued. This was narrowed down to 27 articles that meaningfully commented on barriers that oncologists face in referring to palliative care. Additionally, a qualitative analysis of semi-structured interviews of five practicing oncologists was performed. Oncologists interviewed for the study practice in a cancer center affiliated with an academic tertiary hospital. Results: 20 distinct barriers to referral, both systems-based and at the individual provider level, were enumerated from the literature review and interview analysis. Conclusions: Oncologists face a wide range of specific barriers that prevent appropriate referral to palliative care, related both to the logistics of the healthcare system and to providers’ preconceptions about palliative care. A significant barrier at the oncologist level is a tendency to associate palliative care exclusively with the end of life, despite demonstrated benefits earlier in the course of disease.
The extended care unit: A feasible economic solution for longer-term palliative inpatients.
Authors: Wong Aaron Kee Yee 
Published: February 2017

143 Background: Many inpatient palliative care units (PCUs) in Australia require patients who cannot go home, but remain stable after 2 weeks, to be discharged to nursing homes (NHs). This involves moving between 5 locations (home, acute hospital, PCU, NH transition bed, NH), in the final weeks of life. We propose an “Extended Care Unit” (ECU) to avoid unnecessary moves for such patients. This study aimed to investigate the feasibility of the proposed ECU, including identifying demand, admission criteria, length of stay, and hospital costs. Methods: Using a retrospective, observational design, we censored all inpatients on a single day from the largest tertiary referral centre in the state. 475 files were reviewed. ECU admission criteria used were: prognosis < 90 days, unable to return home, and NH referral process commenced. Two predictive mortality scores were calculated. Total cost was calculated based on average bed cost over 12 months. ECU bed costs were based subacute aged care bed costings. Results: Fifteen (3%) patients met ECU admission criteria. 80% (n = 12) died within 90 days. 60% were transferred between ≥ 4 places. After fulfilling ECU admission criteria, a further 279 acute and PCU bed days were used. If an ECU were available, hospitals would save $207.70 per patient per bed day. Conclusions: The ECU model is a feasible economic solution for this demographic of patients whose needs are currently poorly met. We provide evidence of clear demand, with significant cost savings. Effective admission criteria to identify suitable patients for the ECU are also proposed.
Piloting survivorship care planning with the metastatic breast cancer patient.
Authors: Bantug Elissa Thorner , Saiki Catherine , Zorzi Jane , Stearns Vered , Wolff Antonio C. 
Published: February 2017

146 Background: Emotional distress and poor symptom management are highly prevalent among patients with metastatic breast cancer (MBC). A high disease burden can further negatively impact these patients’ quality of life. To address the evolving survivorship needs in their trajectory from initial diagnosis of advanced disease to end-of-life care, patients with MBC require prompt assessment, reevaluation, and specialized support services. Limited survivorship resources are devoted to this patient population and greater attention to their needs is warranted. Methods: To address the survivorship needs of patients with MBC Johns Hopkins, we developed a new initiative designated a “Living with Breast Cancer” appointment. During this dedicated clinic encounter, a palliative care nurse practitioner works with the patient and her caregiver to develop an individualized “survivorship care plan” that describes medical and psychosocial care, symptom management, nutrition counseling, goal setting, mind/body techniques, palliative care, legacy work, pain management, health screening recommendations, family support, community referrals, and care coordination with oncology providers, among others. Patients with stable MBC are referred to this service by our medical oncology team. Patients are then asked to complete an evaluation survey (either by email or over the phone) 4-6 weeks after the appointment. Results: Since the initiation of program in March 2016, we evaluated 8 patients (3 African-Americans; 3 Caucasian; 2 Asians); mean age is 54.1 years (range, 38-75). Most patients were approximately 1-year post diagnosis of MBC (range, 1-10 years). We are currently collecting and analyzing evaluation survey results. At the time of the meeting, further demographics and evaluation results through August 2016 will be reported. Conclusions: If successful, the Living with Breast Cancer initiative may allow for more patient-centered care of individuals with MBC and their families at Johns Hopkins. The creation of an infrastructure for care coordination, survivorship support services and education aims to promote individualized services within the metastatic setting and improve the quality of life for this population.