bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of support group participation in women with gynecologic cancer.
Authors: Garrick Andrea , Pyrzak Adam , Hu Fengjiao , Sadek Ramses F. , Wheatley Donna , Rungruang Bunja Jane , Ghamande Sharad A. 
Published: February 2017

252 Background: Unlike breast cancer support group literature, there is no data in women with gynecologic cancer who have different perspectives about their disease and therapy. We have a well-established, grass root level support group unique to women with gynecologic cancers that meets monthly. Our goal was to investigate perceived benefits of support group participation. Methods: We developed an original questionnaire to evaluate the CSRA Gynecologic Oncology Support Group (CGOSG) participant’s perceived effects of attending the group on their side effects and disease status which was distributed to patients attending CGOSG meetings. 47 surveys were collected for analysis; Wilcox rank sum test was used as appropriate. Patients were also administered the validated FACT-G questionnaire addressing physical well-being (PWB), emotional well-being (EWB), social well-being (SWB), and functional well-being (FWB). 33 surveys were collected, and t-tests were conducted using FACIT SAS scoring program. Results: In the original questionnaire, the 2 top reasons that patients attended CGOSG were physician driven (28%) and to meet other women with the same diagnosis (26%). The most concerning physical side effect from their cancer or therapy was fatigue (21%), and patients with more than 5 visits reported that CGOSG participation improved their fatigue with a median score of 7.5 ± 4 out of 10. The most concerning emotional side effect was fear of recurrence (26%), and patients reported the CGOSG improved their fear of recurrence with a median score of 9 ± 2 out of 10. Patients with more than one visit, not on treatment reported a higher quality of life score (p = 0.001) and perceived a positive impact on cancer therapy (p = 0.02) compared to patients on treatment. Among patients who took the validated FACT-G questionnaire, those on active treatment had a lower PWB than patients not on therapy (p = 0.01). The mean subscale scores were PWB 21.99, SWB 24.26, EWB 20.08, FWB 20.92 with patients faring best in social well-being. Conclusions: This is a first of a kind attempt to understand the impact of a well-organized support group on women with gynecological cancers which indicates that these women struggle with fear of recurrence but are able to find some solace.
Symptom burden and distress in patients with cancer in Africa.
Authors: Weru John K. 
Published: February 2017

255 Background: Cancer has become a significant public health problem in Africa but still most diagnoses are made late, Sitas et al (2006). The need for palliative care is significant due to the late contact with health care providers and the many symptoms they present with. No study has been undertaken to assess symptomatology for these patients in Africa. Objective: To study the prevalence of symptoms in patients with cancer in an African setting. Methods: Symptom studies from records of patients with cancer referred to the Palliative Care Services at the Aga Khan University Hospital, Nairobi in 6 months. Symptoms charted on Edmonton Symptom Assessment Scale. Results: 42 patients were referred to the service in this period. All the patients reported > 3 symptoms which cut across the physical, social, psychological and spiritual concerns. The most common symptoms were pain in the physical dimension (90%) as reported by the patient. Fatigue was reported by (93%).Family wellbeing was the main worry in psychological dimension (95%). 94 % reported social disconnect due to the diagnosis, job losses and huge cost of health care. 96% suffered from the existential question of why me and worry about the future. Conclusions: Cancer has become a major burden to patients, families, societies and nations in Africa. Patients suffering from this illness experience a myriad of symptoms which require holistic approach to care. Social wellbeing remains a major concern for patients with cancer in Africa.
Survivor pain: Experience at an oncology palliative care clinic.
Authors: Zanartu Cristian , Emond Lisa , Wojtaszczyk Ann 
Published: February 2017

260 Background: As of January 2014 there are an estimated 14.5 million cancer survivors in the United States. In observational studies of cancer survivors up to 40% report chronic pain. Opioids remain an important and effective treatment for active cancer pain. For survivors, however, we must take into account the paucity of data supporting long term benefits of opioids on pain and functional outcomes, and extensive evidence of potential harms. We present data from our palliative care clinic where we have established a nuanced approach to pain management in this population, which includes risk mitigation, consistent education, emphasis on non-pharmacological and non-opiate medications, and attempts to down-taper opioid analgesics when feasible. Methods: Retrospective, observational chart review of 62 patients identified as cancer survivors, who have been managed for pain, at an academically affiliated palliative care clinic embedded in the oncology department. Demographic information, baseline and latest visit pain scores and functional assessments, as well as pain regimen data were collected. Means for pain and functionality scores were compared for those patient’s with differing opioid regimens and nonpharmacological treatments. Results: Of the 62 patients reviewed, 48 were tapered off opioid medication. In the patients who were tapered off opioid medications, 8 (16%) showed an increase in average pain scores, 11 (22%) showed no change in average pain scores, and 29 (60%) showed improvement in average pain score. Conclusions: In 82% of the patients whose opioid medications were decreased, average pain scores either remained the same or actually improved over time. This is encouraging data to support the theory that decreasing opioids in cancer survivors does not worsen pain control in the majority of that population.
A novel risk stratification model for patients with brain metastasis: Incorporating with physiological signals.
Authors: Wang Yu-Ming , Ho Tsung-Ying , Huang Eng-Yen , Wang Chong-Jong 
Published: February 2017

38 Background: Brain metastasis (BM) develops in 10%-40% of patients with malignancies. Survival expectancy is critical for choosing an optimal treatment for BM patients. Previous reports have proposed different risk stratification systems based on clinical and image-related factors. Heart rate variability (HRV), a physiological factor, has also been reported as a novel prognosticator for BM patients. In this study, we proposed a novel risk stratification model for BM patients by incorporating HRV signals. Methods: Patients with BM referred to our department for palliative RT were prospective recruited. Those who were not suitable for HRV evaluation were excluded for analysis. A 5-minute ECG was acquired before treatment started for each patient for subsequent HRV signal analysis. All patients underwent WBRT for 30-37.5 Gy in 10-15 daily fractions. Local boost to gross intracranial tumors were performed selectively. The primary end-point for this study was overall survival (OS). Survival analysis was carried out by Kaplan-Meier method and factors were compared by log-rank test and cox-regression. A novel risk stratification model combining HRV index SDNN and KPS was proposed. Results: Total 62 patients were recruited from Jan 2010. The median follow-up time was 40.7 months for patients who were still alive. Only 1 patient (1.6%) met the criterion of RPA class I. The median OS for all patients was 4.5 months. Univariate and multivariate analysis revealed that SDNN ≥ 10ms and KPS ≥ 70 were independent survival prognosticators. For a selected group of patients (n = 29, Group 1, SDNN ≥ 10ms and KPS ≥ 70) the median OS was 9.9 months, which is significantly higher than the rest 33 patients (Group 2) as of 2.4 months. The 3-month/6-month OS rate in Group 1 and Group 2 were 82.8%/72.4% and 36.4%/24.2% (p < 0.001). Conclusions: Using physiological factors for risk stratification is novel. Our results demonstrated that a group of patients with potential longer survival could be selected by using HRV index and KPS. This group of patients should be considered differently in treatment selection. Further studies are warranted to validate our findings and improve the quality of care in patients with BM.
Attitude and support to inform clinical predictions of survival in patients with advanced cancer.
Authors: Fairchild Alysa M. , Ma David L , Paulson Kim , Ghosh Sunita , LeGuerrier Bronwen , Chu Karen P , Severin Diane , Huang Fleur , Watanabe Sharon , Huot Ann , Amanie John , Patel Samir , Nijjar Tirath , Wiebe Ericka , Danielson Brita Lavender , Debenham Brock J 
Published: February 2017

39 Background: Tumour factors (eg primary site, size) helpful in prognostication in early stage cancer may be less important than patient factors, such as Karnofsky performance status (KPS), later in the disease trajectory. We evaluated the utilization of the parameters attitude (ATT) and psychosocial support (PSS) in predicting remaining lifespan by two experienced multidisciplinary teams (MDT). Methods: After clinical assessment of consecutive patients, a quantitative clinical prediction of survival (CPS) was made prospectively, independently and anonymously by each health care provider (HCP). HCP recorded up to 4 factors (free-text) influencing their CPS. The Palliative Radiation Oncology (06/2010-12/2014) and Palliative Care (06/2012-01/2014) teams participated. Demographics, disease information, and date of death were abstracted. Summary statistics (means, standard deviations, and proportions) were calculated. Estimates for actual survival (AS) were obtained. Wilcoxon tests compared continuous variables and chi-square tests were used for categorical variables. Results: 2,582 predictions were made by 11 disciplines for 881 unique patients over 1,054 clinic visits. Median age was 66 years, 58.6% were male and 37.3% had lung cancer. KPS, when recorded, was ≥ 70 at 46.3% of visits. Cognitive status was below expected for 174/460 visits. Mean AS was 177 ± 190 days and mean CPS was 258 ± 300 days. The median number of factors cited was 4 (range 0-4), with disease extent most common. ATT and PSS as perceived by the HCP influenced 6.7% and 5.8% of CPS respectively, varying across disciplines (p < 0.0001). Overall, mean CPS was significantly longer when ATT (337d vs 252d; p < 0.0001) or PSS (310d vs 254d; p < 0.004) was quoted. CPS estimates by Nursing and Students were longer when ATT was mentioned (both p < 0.004). Students’ CPS were longer when PSS was described (p = 0.048). Mean AS was also longer when ATT (259d vs 178d; p < 0.0001) or PSS (224d vs 181d; p = 0.03) were cited overall, as well as within the Nursing, Student and Pharmacist groups (all p < 0.05). Conclusions: Attitude and available psychosocial support as evaluated by MDT appeared to correlate with both clinical prediction of survival and actual survival in this cohort.
Patients' perception of palliative treatment objectives.
Authors: Elsayed Ahmed Gamal , Tirona Maria R. B. Tria 
Published: February 2017

43 Background: Palliative chemotherapy and radiation are often used in patients with advanced stage of cancer. To weigh the risks and the benefits of this treatment, patients need to be adequately informed about all treatment aspects including the side effects and potential benefits. Unfortunately, many patients are not well informed about the goal of their treatment, and many are under the impression that this treatment can be curative. Methods: This is a prospective survey based study that enrolled 46 patients with stage IV disease of all solid malignancies, who are being treated with palliative intent at the Edwards Comprehensive Cancer Center. Patients were given a questionnaire designed to test their level of knowledge of their current treatment goals, and to evaluate the efforts of health care team to educate patients. Results: 35% of patients had lung cancer, 34% had GI cancer, 14% had breast cancer and 13% had GU cancers. 37% of patients were under the impression that they are receiving curative treatment, 28% were not sure about the goals of the treatment, while only 35% of patients understood that the treatment was not curative. 91% of patients received written educational material. 93% of patients chose personal communication with the physician as their preferred method of getting educated about their disease. Conclusions: Our data shows that most of the patients at our local cancer center who are actively receiving treatment with palliative intent are satisfied with amount of time spent with physician and have received written educational material. Despite these efforts, a majority of patients are still not clear on the treatment goal. Most patients chose personal discussion as the preferred method of education. Hence, physicians on staff were informed about the results and further emphasis on treatment goal during counseling is being undertaken. [Table: see text]
ICU deaths in patients with advanced cancer: Criteria to decrease potentially inappropriate admissions and analysis of advance planning discussions.
Authors: Nasir Syed Sameer , Weir Alva B 
Published: February 2017

47 Background: A significant number of advanced cancer admissions to intensive care unit (ICU) are inappropriate, as they do not prolonged survival. No clear consensus criteria for reasonable admissions of advanced cancer patients have been developed. Methods: We established four criteria for ICU admissions in advanced cancer patients: post procedure complication, recent cancer diagnosis, good performance status and life expectancy of > 6 months. We reviewed charts of all patients who died in the ICU at a university-affiliated hospital between 2005-2010. We then identified advanced cancer patients and looked for presence or absence of these criteria. We also reviewed evidence of advance planning discussions (APDs), prior to ICU admission to evaluate their benefit in preventing inappropriate admissions. Results: 421 deaths occurred in ICU between 2005-2010. 52 patients had advanced cancer. 27% were diagnosed with cancer one month or less prior to admission. 40% had ECOG performance status of 0-1. 27% had life expectancy of more than 6 months and 15% were admitted for post procedure complications. Overall, 37% did not satisfy any of our reasonable criteria at the time of ICU admission. In our chart review for evidence of APDs, 31% had completed APDs prior to ICU admission. 47% of patients who did not satisfy any of our reasonable admission criteria had APDs indicating desire for limited medical intervention. Patients lacking both reasonable admission criteria and APDs were 15%. Conclusions: Incorporating proposed admission criteria in ICU admission guidelines may prevent significant number of inappropriate, advanced cancer admissions to the ICU, thus avoiding ineffective, aggressive interventions and delay in timely access to high-quality hospice and palliative care. Our data confirms other data in suggesting that a simple increase in numbers of APDs would not likely change significantly the numbers of inappropriate ICU admissions. [Table: see text]
Decision of palliative chemotherapy in late-stage cancer: The doctor-patient relationship and the decision-making process as seen by an oncologist.
Authors: Scotte Florian , Pechard Marie , Krakowski Ivan , Tournigand Christophe , Viallard marcel-Louis 
Published: February 2017

48 Background: We conducted a literature review on the administration of palliative chemotherapy in cancer patients at advanced stage. We wondered about ethical tensions encountered by the oncologists during the decision process to meet or not the patients' demand to have access to a palliative chemotherapy at a late stage of the disease. Methods: We conducted a multicenter, qualitative study of senior oncologists in university hospitals and cancer centers in France, by carrying out interviews with eleven oncologists. Results: The study are consistent with the literature showing that factors are in favor of treatment continuation: the patient's age, his desire to continue treatment and his life expectancy. The decision making process of chemotherapy discontinuation is marked by uncertainties, personal representations of the doctor and subjectivity in front of the objective facts that could make this decision difficult. The working conditions in cancer care and the valuation of the chemotherapy prescription can impact the decision. The constant medical progress in oncology make more complex the decision of stopping specific treatments. This study showed the singularity of the doctor-patient relationship in oncology. This can explain the difficulty to stop chemotherapy. Conclusions: The oncologist can use the collegiality which are necessary for decision to limit specific treatment. The objective is to propose the adequate care to the patient in all its dimensions. Some actions can be proposed to improve our practice: early use of palliative care for patients, analysis of practices and training to deal with uncertainty and the limits of possibilities in clinical practice.
Emotional disclosure in home hospice cancer care: Implications for spouse caregiver bereavement.
Authors: Reblin Maija , Ellington Lee , Clayton Margaret , Caserta Michael , Lund Dale , Mooney Kathi 
Published: February 2017

54 Background: Evidence shows the benefit of positive and negative emotional disclosure for family caregivers (CG), but little is known about the impact of emotional disclosure at end of life. We assessed the effect of CG and hospice nurse disclosure during home visits on CG anxiety and depression in bereavement. Methods: As part of a larger study, nurse visits to 95 spouse CGs of cancer home hospice patients were audio recorded. An adapted Roter Interaction Analysis System was used to identify emotional disclosure: CG and nurse positive emotion (humor, gratitude), CG distress, and nurse emotional response (reassurance, validation). CGs completed demographics at hospice enrollment, and HADS anxiety scale, and Geriatric Depression Scale (GDS) at enrollment, and 2, 6 and 12 months after patient death. Growth curve analysis was conducted to predict HADS and GDS trajectories, controlling for CG gender, total talk, anxiety and depression at enrollment. Results: Average spouse CG age was 65; 60% were female and 98% were white. There were no GDS effects for CG expression of distress or nurse emotional response. Higher CG positive emotion talk predicted higher GDS at 2 months (B = .18, p < .01), but a significant decline of GDS over time (B = -.08, p = .03). There were no effects for CG emotional disclosure on anxiety. However, more nurse emotional response predicted lower anxiety at 2 months (B = -.10, p = .02) which did not significantly change over time. More nurse positive emotion did not impact anxiety at 2 months, but predicted lower anxiety over time (B = -.04, p = .04). Conclusions: Emotional disclosure during cancer hospice visits was associated with spouse CG bereavement trajectories. CG positive emotion talk may signal increased potential for depression early in bereavement, but appears to lessen over time. CGs who express more positive emotion, which includes humor, gratitude and savoring the moment, may be more sensitive to loss, but appear to recover in time. Nurse expression of reassurance and validation, and of positive emotions seems to be effective in addressing and normalizing CG anxiety during bereavement. These findings have potential implications for communication interventions.
Survival benefits among patients with end-stage renal disease receiving dialysis versus no dialysis.
Authors: Dahbour Ibrahim Nayef , Abdelrahim Maen , Page Valda D , Zhou Shouhao , Shen Chan , Yennu Sriram , Zhao Bo , Manzano Joanna-Grace Mayo , George Marina Ciny , Nates Joseph L. , Moss Alvin Howard , Pai Rima , Abudayyeh Ala 
Published: February 2017

55 Background: Retrospective study of the outcomes of Stage IV Cancer Patients with End Stage Renal disease Receiving Dialysis and comparing the survival benefits among the patients who received Hemodialysis versus who didn’t at a Comprehensive Cancer Center. Methods: Retrospectively review all patients admitted to MDACC from 2005-2014 and diagnosed with stage IV solid tumor admitted with Acute kidney injury and a nephrology consult were included (N = 903) 19.82% received dialysis (n = 179) versus 80.17% did not receive dialysis (n = 724). The main endpoints of the study to be evaluated would be survival & hospital death. Results: Kaplan-Meier overall survival curve of the dialysis group vs the non-dialysis p-value < 0.001 indicating that patients who underwent dialysis had a poorer overall survival. This was further explored in a multivariate model where at any given time; a patient who underwent a dialysis is 1.318 times as likely to experience a death as a patient who did not undergo a dialysis with the same other clinical factors. The association between dialysis and death in hospital was explored using multivariate model indicated dialysis (odds ratio = 3.339, 95% CI (2.212, 5.04), p < 0.001, ICU (odds ratio = 2.624, 95% CI (1.905, 3.613), p < 0.001), and a lower serum albumin level (p < 0.001) are factors associated with a higher probability of death in hospital. Matched sample where evaluated using propensity score matching & Weighting and the dialysis group still shows a significant negative effect on Overall Survival with (p = 0.003). ICU patients Subset Analysis & SOFA Score: 49.9% had ICU visits in our database with SOFA scores (37.9% were dialyzed). Using propensity score weighting method, the estimated hazard rate is 0.892 with 95% CI (0.775, 1.027) and p = 0.113, showing NO evidence that dialysis is a prognostic factor for ICU patients after controlling SOFA score. In the ICU cohort, the median survival time for dialysis 18 days (95% CI: 14-23) and no dialysis 19 days (95% CI: 15-25). Conclusions: We can conclude that Dialysis when offered to advanced cancer patients does not improve mortality. Creating a hemodialysis prognostic tool relevant to cancer population would be of great benefit to Nephrologists, Oncologist and patients.