bluuebunny/crossref_metadata_2025_split huggingface dataset:
Yoga program for patients with brain tumors undergoing radiotherapy (XRT) and their family caregivers.
Authors: Milbury Kathrin , Mallaiah Smith , Mahajan Anita , Armstrong Terri S. , Weathers Shiao-Pei S. , Moss Kathryn E , Goktepe Nazli , Spelman Amy , Cohen Lorenzo 
Published: February 2017

200 Background: The role of behavioral medicine in the symptom management of glioma patients is largely unknown. Moreover, although the literature revealed that family caregivers are at risk of physical and psychological burden, the needs of caregivers generally remain unaddressed. The purpose of this study was to establish feasibility and preliminary efficacy of a couple-based Yoga (CBY) intervention in glioma patients and their caregivers targeting QOL outcomes. Methods: This small, single-arm pilot trial included adults with low and high grade glioma undergoing XRT and their family caregivers. Dyads participated in a 12-session CBY program focusing on breathing exercises, gentle movements and guided meditations. We tracked feasibility data and assessed levels of cancer-related symptoms (MDASI), depressive symptoms (CES-D), fatigue (BFI), sleep disturbances (PSQI), spiritual well-being (FACT-SP) and overall mental and physical QOL (SF-36) at baseline and post-CBY, which was at the end of XRT. Participants also completed program evaluations. Results: We approached 7 dyads of which 5 (71%) consented. All participants completed all 12 sessions and pre/post assessments. All patients (mean age: 52 yrs., 80% female, 80% high grade) and caregivers (mean age: 58 yrs., 60% female, 60% spouses) indicated that they perceived benefit from the program. Paired t-tests revealed a marginally significant, yet clinically meaningful, decrease in patient’s cancer symptoms (t = 2.32, p = .08; MDASI mean; 32.06 vs.18.80). There were clinically significant reductions in patient sleep disturbances (PSQI mean: 10.75 vs. 8.00) and improvements in patient and caregiver mental QOL (MCS of SF-36 mean: 42.35 vs 52.34 and 45.14 vs 51.43, respectively). All other means were generally in the expected direction. Conclusions: This novel supportive care program appears to be safe, feasible, acceptable, and subjectively useful for glioma patients and their caregivers. Although the trial did not have a control group, it is notable that multiple symptom outcomes improved when they would normally have been expected to deteriorate over the course of XRT. We are currently conducting a randomized controlled trial to examine treatment efficacy. Clinical trial information: 2015-01124.
The requirement of fentanyl patch in terminally ill patients with cancer.
Authors: Shimada Naoki , Watanabe Aya , Ishiki Hiroto , Chiba Tsukuru , Kinkawa Junya , Watanabe Chie , Ariyoshi Keisuke , Nojima Masanori , Iwase Satoru , Tojo Arinobu 
Published: February 2017

202 Background: Cancer pain is the most important problem to overcome in terminally ill cancer patients (TICPs). Recently, the fentanyl patch (FP) has been widely used for the treatment of cancer pain. However, the FP requirement largely varies in patients. The purpose of this study was to identify the determinants of the FP requirement in TICPs and propose effective pain relief using a FP. Methods: In a retrospective chart review, we investigated cancer patients who were admitted in our hospital from April 2012 to July 2015 and used FP until their deaths. We examined the time course of FP use in TICPs until death. We used descriptive statistics and a mixed effect model. The primary endpoint of this study was the final dose of FP use (FDFP). Results: Eighty patients were included the analysis. The clinical characteristics were as follows: age (median, range): 64.5 (29-88) years; male/female ratio: 40/40; primary tumor sites: pancreas (n = 33), digestive tract (n = 12), liver and bile duct (n = 7), ovary and uterus (n = 6), hematologic (n = 5), lung (n = 4), head and neck (n = 4), breast (n = 3), and other (n = 6). FDFP was inversely correlated with age (R = -0.272, P < 0.05; Spearman test). The FDFP (mean ± SD) administered in the patients was 3.06 ± 3.20 mg/day (Male/Female: 3.83 ± 4.06/2.29 ± 1.81 mg/day). The FDFP was 4.36 ± 4.32/2.15 ± 1.64 mg/day in patients with/without pancreatic cancer. FDFP was significantly higher in male than in female patients (P < 0.05; student’s t test), and also significantly higher in patients with pancreatic cancer than in patients without pancreatic cancer (P < 0.005; student’s t test). In pancreatic cancer patients, the FP adjustments were more frequent in the last 60 days of life than in patients with other malignancies (P for interaction < 0.001; mixed effect model). Conclusions: We found that younger age, male sex, and pancreatic cancer were risk factors for higher requirement of FP in TICPs. TICPs with pancreatic cancer in particular required more frequent adjustment of FP near death. We should consider quick titration of fentanyl in patients with pancreatic cancer because the pain-relieving action of FP requires time.
Effects of high-dose Asian ginseng (Panax ginseng) to improve cancer-related fatigue: Results of a double-blind, placebo-controlled randomized controlled trial.
Authors: Yennu Sriram , Tannir Nizar M. , Williams Janet L. , Hess Kenneth R. , Frisbee-Hume Susan , House Helen L , Fossella Frank V. , Lim Zita Dubauskas , Lopez Gabriel , Reddy Akhila Sunkepally , Azhar Ahsan , Wong Angelique , Patel Sunil M. , Kaseb Ahmed Omar , Hwu Wen-Jen , Lu Zhanni , Cohen Lorenzo , Bruera Eduardo 
Published: February 2017

209 Background: Cancer related fatigue (CRF) is the most common and disabling symptom in cancer.Panax ginseng extract (PG) is frequently used as a nutraceutical treatment for fatigue. There are no well-powered placebo-controlled trials that used validated CRF outcome measures to investigate of PG effects in cancer patients. The primary objective of this trial was to evaluate the effects oral PG versus Placebo (PL) for CRF. Methods: Patients with cancer fatigue ≥ 4/10 on Edmonton Symptom Assessment Scale (ESAS) were eligible. Patients were randomized to either 400mg of standardized PG or matching PL orally twice a day for 28 days. The primary endpoint was change in the Functional Assessment of Chronic Illness-Fatigue (FACIT-F) fatigue subscale from baseline to Day 28. Secondary outcomes were Functional Assessment of Cancer Therapy-General (FACT-G), Hospital Anxiety and Depression Scale (HADS), and ESAS. Results: Total evaluable patients were 112 (56 for PG and PL groups). No significant differences in baseline characteristics between the two groups except cancer type (p = 0.002). There was significant improvement in FACIT fatigue and ESAS fatigue scores in PG and PL groups at Day 15 and Day 29. The mean (SD) of FACIT-F fatigue scores at baseline, Day 15, and Day 29 were 22.6 (10.4), 29.8(10.7), 30.1 (11.6) and 23.8 (9.1), 30.0 (10.1), 30.4 (11.6) for PG and PL respectively. Mean (SD) improvement in the FACIT-F subscale at Day 29 was not significantly different in PG than in the PL group [7.5 (12.7) vs 6.5 (9.9), P = 0.67]. Mean (SD) improvement in the ESAS fatigue, FACT-G, and HADS at Day 29 were also not significantly different in PG than in the PL group. In a multiple linear model analysis, the change in FACIT-F fatigue from Day 0 to Day 29 was negatively correlated with baseline FACIT-F fatigue (p = 0.0005), baseline HADS score (p = 0.032), and male gender (p = 0.023). There were a significantly higher number of any grade of toxicities in PL group than in PG group (33/62 vs. 28/64, p = 0.024). Conclusions: Both PG and Placebo result in a significant improvement in CRF at Day 15 and Day 29. PG was not significantly superior to placebo after 4 weeks of treatment. Further studies are needed. Clinical trial information: NCT01375114.
Efficacy and safety of methadone in the treatment of pain in palliative care patients with cancer: The EQUIMETH2 national, randomized, open, phase III study.
Authors: Poulain Philippe , Berleur Marie Pierre , Lefki Shimsi , Lefebvre Kunt Daniele , Serra Eric , Chvetzoff Gisele , Derniaux Alain , Tremellat Flora , Filbet Marilène , Simon Anna , Dang Vu Bich , Guillaume Cyril 
Published: February 2017

212 Background: Methadone is used more and more as a second-line treatment for refractory cancer pain in palliative care patients. Methods: The study aimed to compare the effect of two methadone titration methods (Stop and Go vs progressive titration) in 146 palliative care cancer patients with pain inadequately relieved or intolerant to level 3 opioids. The primary endpoint was the rate of success/failure at Day 4 defined by pain relief (reduction of at least two points of the numerical scale (0 - 10) AND a pain score < 5 for 2 consecutive days) AND no overdose (Rudkin scale ≥ 3 AND respiratory rate < 8/min). Results: Pain was nociceptive in 16% and mixed in 84%. 85% of the patients had breakthrough pain. Half received oxycodone, 1/5 fentanyl, 1/5 morphine and < 10% hydromorphone. Reasons for switching were lack of efficacy isolated (56%), or with intolerance to previous opioid (38%). More than 2/3 of the patients reached a pain score < 5 for two days at D4, adequate pain relief was obtained in 80% of the patients (median of 3 days in both groups (p = 0.12)) and lasted until D56. The rate of success/failure was about 40% at D4 with no difference between the two methods. Overdoses defined as respiratory rate < 8/min were observed in 13.2% patients throughout the study with no difference between groups. 9 required naloxone. The two methods were equally considered easy by about 60% of the clinicians. Conclusions: Methadone is an effective and sustainable second-line alternative opioid in the treatment of cancer pain in palliative care patients inadequately relieved or intolerant to level 3 opioids. The two methods of titration of methadone are comparable in terms of efficacy, safety and ease of use.
Association between anti-cholinergic burden and delirium among patients with advanced cancer referred to a palliative care consult service.
Authors: De La Cruz Maxine Grace Jaucian , Baidoo Joseph , Balankari Vishidha Reddy , Waletich-Flemming Jessica Marie , Delgado-Guay Marvin , Wu Jimin , Liu Diane D , Bruera Eduardo 
Published: February 2017

213 Background: Delirium occurs in about 45-60% hospitalized patients and 80-85% at the end of life. Predisposing factors include anti-cholinergic medications as is often cited in the geriatric literature. Our study aimed to demonstrate the association of anti-cholinergic burden and delirium in patients with advanced cancer. Methods: Retrospective review of 775 consecutive patients seen by the palliative care inpatient consult team. Demographic data, MDAS, ECOG, and anti-cholinergic drugs were determined. Anticholinergic burden was measured using the anticholinergic drug scale (ADS), anticholinergic risk scale (ARS), and anticholinergic burden scale (ACB). Patients with delirium and those who did not develop delirium were compared. Association between delirium and anticholinergic use were analyzed using Chi-squared test, univariate and multivariate logistic regression models. Results: 270/775 (35%) had delirium at the time of consult. Median age was 58 years. The median total of anticholinergic drugs in both groups was 6. Anticholinergic burden using the ADS (median 2 vs. 3; p = 0.09) and ARS (median 0 vs. 1; p = 0.75) was not different in both groups. ACB score were significantly different in both groups (median 1 vs 2; p = 0.0006). Univariate analysis showed hematologic malignancy (OR = 1.85, 95%CI: (1.23, 2.77), p 0.0030, poor ECOG, age (OR = 1.03, 95%CI: (1.02, 1.04), p < 0.0001) and ACB score (OR = 1.11, 95%CI: (1.03, 1.21), p 0.0069 to be associated with delirium. In our multivariate model ECOG (OR = 0.25, 95% CI: (0.17, 0.36), p < 0.0001), and age (OR = 1.03, 95% CI: (1.01, 1.04), p < 0.0001) are the only independent covariates significantly associated with the presence of delirium at admission. Conclusions: Our study found that in this younger population with cancer, the total number of anticholinergic drugs and the anticholinergic burden using 3 different scales were not associated with delirium suggesting a different mechanism. Further studies are needed to confirm these findings.
Palliative whole brain radiotherapy: Predictors of prescribing 5 versus 10 fractions.
Authors: Duimering Adele , Baker Sarah , Paulson Kim , Debenham Brock J , Ghosh Sunita , Ma David L , Huang Fleur , Chu Karen P , Severin Diane , Amanie John , Nijjar Tirath , Patel Samir , Wiebe Ericka , Danielson Brita Lavender , LeGuerrier Bronwen , Fairchild Alysa M. 
Published: February 2017

219 Background: The optimal dose for palliative whole brain radiotherapy (WBRT) continues to be debated. Common regimens include 20 Gy in five and 30 Gy in 10 fractions. We aimed to identify factors associated with WBRT dose schedules, hypothesizing that clinical prediction of survival (CPS) would influence prescribing practice. Methods: Demographic and clinicopathologic data were collected for consecutive patients with brain metastases receiving WBRT through a dedicated palliative radiation oncology clinic. At initial consultation, CPS were prospectively collected from treating radiation oncologists. Karnofsky performance status (KPS) and Mini-Mental Status Examination were available for 88.6% and 75.1%, respectively. Dose fractionation was collected and summary statistics calculated. Parameters were assessed for association with five fraction schedules using binary logistic regression, with odds ratios and 95% CI reported. Results: 193 patients underwent WBRT (N = 102 from 2010-2012; N = 91 from 2013-2014); 38/193 had 48 extracranial sites irradiated concurrently. 46.1% were male, mean age was 64.7 years (SD 11.6), and 63.7% had lung cancer. Median KPS was 70 (range 20-100) and median MMSE score was 27/30 (range 13-30). Median CPS and actual survival were 150 days (range 21-730d) and 96 days (range 11-1029d), respectively. 18.7% received WBRT within 30 days of death. 78.2% (151/193) and 17.6% (34/193) received five and 10 fractions, respectively; 8/193 were prescribed other schedules. On multivariate analysis, patients with KPS ≤ 70 were 5.93 times more likely to have received 5-fractions (95% CI 2.51-14.1; p < 0.0001). Those treated 2010-2012 were less likely to have received 5 fractions (OR 0.28; 95% CI 0.11-0.68; p = 0.005). CPS, age, gender, MMSE, histology, disease extent, and extracranial irradiation were not predictive of WBRT schedule. Conclusions: Patients treated with WBRT with KPS ≤70 and those treated more recently were more likely to receive five fractions. Oncologist CPS was not a statistically significant predictor of schedule in this cohort.
Novel tool utilized as a trigger for advance care planning in hospitalized oncology patients.
Authors: Lincoln Nicole , Rao Sandhya , Sarnacki Diane , Dobie Alexandra , Damus Karla , Gignac Gretchen 
Published: February 2017

22 Background: Study Purpose: reduce inpatient oncology readmissions; determine if there is a need to standardize trigger for Advance Care Planning in the inpatient oncology population. Methods: Investigational Quality Improvement Study January-June 2014. Retrospective chart review of oncology readmissions on the BMC Hematology and Oncology service during a 6 month period, January-June 2013 (N = 68). Data abstracted included: demographics (age, race/ethnicity, primary language, education, marital status, ECOG); type and stage of cancer; type of consults (palliative, spiritual, social services, integrative, PT/OT, hospice, visiting nurse). Developed a Severity of Illness Scale for use in the oncology inpatient patients at BMC. Results: Mortality rate within 1 year of discharge: 32.8% (non-elective readmissions) 19/58; mean days to death from readmission discharge: 65 days (range 0-252); 84.2% of those who died had metastatic cancer in index admission; only 37% ever had a palliative care consult placed (all on readmit); only 17% had a documented EOL discussion on index admission; 38.5% of patients had lung CA (22% of all non-elective readmissions). Conclusions: (1) There is a need to standardize triggers to goals of care discussions and access to Palliative Care in the Hematology/Oncology Inpatient Population at this Institution. (2) Readmissions may be reduced with better Advance Care Planning. (3) There is a communication gap amongst interdisciplinary teams in regards to Advance Care Planning at this institution. Currently IRB Approval for use of novel severity of illness scale on a maximum 450 patient sample (current N = 300) at daily rounds administered in all inpatients admitted to the Hematology/Oncology Service January 4, 2016-June 30, 2016. Preliminary data shows 25-30% of study sample scoring in for Advance Care Planning with a score of greater than or equal to 4 on novel tool (BMC Cancer Care Severity Of Illness Tool).
The benefits and burdens of cancer: A prospective, longitudinal cohort study of adolescents and young adults.
Authors: Straehla Joelle P. , Shutske Krysta , Yi-Frazier Joyce P. , Wharton Claire M , Baker Kevin Scott , Bona Kira O'Neil , Wolfe Joanne , Rosenberg Abby R. 
Published: February 2017

243 Background: Much of the literature describing psychosocial consequences of cancer among adolescents and young adults (AYAs) has reported negative outcomes; however, AYAs also have potential for protective, positive outcomes. We aimed to prospectively characterize AYA patient-reported benefit and burden-finding after cancer diagnosis and hypothesized that benefit finding would be a salient coping mechanism. Methods: Semi-structured, 1:1 interviews were conducted with AYA patients after cancer diagnosis at 3 time points over 2 years, to elicit their expectations, hopes, worries, personal strengths, and challenges. A priori coding themes were defined from validated scales: changed sense of self, relationships, philosophy of life, and physical well-being. Verbatim transcripts were coded using content analyses by 3 independent coders for instances of benefit or burden by construct. Raw counts, ratios, and confidence intervals were calculated and compared by patient and time point. Results: Seventeen patients (mean age 17.1 ± 2.7; 8 [47%] male) completed 44 interviews with > 100 hours of transcript-data. Most common diagnoses were sarcoma (n = 8), acute leukemia (n = 6), and lymphoma (n = 3). Twelve patients completed all 3 interviews; reasons for withdrawal included death in all but 2 cases. Mean (±SD) counts of patient-reported benefit were higher than burden at each time point (T1, T2, T3); the benefit: burden ratio was > 1 in 68% of interviews (Table). Of the themes, changed sense of self was the most common benefit identified (44% of all reported benefits [95% CI 37%, 52%]) whereas physical complaints was the most common burden (32% [95% CI 25%, 39%]). Longitudinal analysis of subthemes among patients completing 3 interviews (N = 12) indicated an increase in self-identified positive and negative impact of cancer on personal, social and existential perspectives. Conclusions: AYA patients with cancer identified more benefits than burdens related to their diagnoses at all times studied. There was a shift over time in the distribution of benefit and burden finding constructs which may highlight areas for potential intervention. [Table: see text]
Differences in perceptions of smoking and second-hand smoke (SHS) in palliative and nonpalliative patients with cancer.
Authors: Mohan Rahul , Alton Devon , Su Jie , Song Yuyao , Farzanfar Delaram , Krys Olivia , Yoannidis Tom , Milne Robin , Brown M Catherine , Hope Andrew J. , Howell Doris , Jones Jennifer M. , Selby Peter , Xu Wei , Goldstein David Paul , Giuliani Meredith Elana , Liu Geoffrey , Eng Lawson 
Published: February 2017

251 Background: With improvements in cancer therapies, palliative patients with cancer now enjoy improved and sometimes prolonged survival. Continued smoking after a cancer diagnosis negatively impacts treatment response/toxicities, survival and quality of life and is influenced by SHS exposure. Little is known about the perceptions of palliative patients with cancer in comparison to patients who are considered potentially curative, on smoking after a cancer diagnosis and of SHS exposure. We assessed such potential differences in perception. Methods: Patients with cancer across all sites were surveyed with respect to their smoking habits and perceptions on how smoking and SHS influences cancer-related QofL, fatigue and overall survival (OS). Review of patient charts confirmed which patients were considered palliative versus potentially curative. Multivariable logistic regression models assessed for associations between treatment intent and patient perceptions, adjusted for significant co-variables. Results: Among 985 patients with cancer, 22% were considered palliative; 23% of surveyed patients smoked at diagnosis; 10% continued smoking at follow-up. Most patients perceived that continued smoking and SHS exposure negatively impacted QofL (continued smoking: 83%, SHS: 82%), fatigue (83%, 79%) and OS (86%, 81%). Palliative patients were more likely to believe that SHS worsened their cancer-related fatigue (adjusted odds ratio (aOR) = 1.65, 95% CI [1.05-2.56], P = 0.03) and worsened OS (unadjusted OR = 1.92, [1.12-3.33], P= 0.02; aOR = 1.56 [0.98-2.50], P = 0.06). Yet palliative/non-palliative status was not found to be associated with perceived benefits of smoking cessation on QofL, fatigue, or OS (P > 0.10, all comparisons). Conclusions: When compared with non-palliative patients, palliative patients with cancer perceived a greater negative impact of SHS on fatigue and survival, but had similar views of continued smoking after a cancer diagnosis. We are encouraged that palliative status did not lead to patients having diluted perceptions on the negative impact of smoking on cancer outcomes. Health care providers should continue to focus on the positive impacts of smoking cessation and SHS in this setting.
Differences between women’s preferred and actual experience with ‘shared decision-making’: A mixed method study.
Authors: Ejem Deborah , Dionne-Odom J Nicholas , Willis Danny , Kaufman Peter , Urquhart Laura , Bakitas Marie 
Published: February 2017

34 Background: Women with metastatic breast cancer (MBC) face numerous treatment and ACP decisions along their illness trajectory. We aimed to explore the treatment and ACP decision-making processes and decision support needs of women with MBC. Methods: Convergent, parallel mixed methods study (9/08-7/09). Sample included women with MBC managed by 3 breast oncologists at the Norris Cotton Cancer Center, Lebanon, NH. Participants completed a semi-structured interview and standardized decision-making instruments (decision control preferences) at study enrollment (T1; n = 22) and when they faced a decision point or 3 months later (T2; n = 19), whichever came first. Results: Participants (n = 22) where all white, averaged 62 years and were mostly married (54%), retired (45%), had a ≥ bachelor’s degree (45%), and had incomes > $40,000 (50%). On the control preferences scale, most women reported a preference for a ‘shared decision’ with clinician (T1 = 14 (64%) vs T2 = 9 (47%)) compared to making the decision themselves (T1 = 6 (27%) vs T2 = 6 (32%)), or delegating the decision to their doctor (T1 = 2 (9%) vs T2 = 4 (21%)). In semi-structured interviews about their actual treatment decision-making experience, women described experiencing a passive or delegated rather than a shared decision-making process. Conversely, women described a much more active ACP decision-making process that was often shared with family rather than their oncologists. Conclusions: Women selected a “shared” process using a validated tool; however their descriptions of the treatment decision-making processes were inconsistent with their actual experience, which was a more passive process in which they followed the oncologists’ treatment suggestions.