bluuebunny/crossref_metadata_2025_split huggingface dataset:
Analgesic treatment and pain killer use in patients enrolled at Pain Control Center Hospice of Solofra (Italy).
Authors: Genua Geppino , Rizzo Luisa M , Fasano Mela , Fina P. Lino , De Vinco Elena , Strollo A. M. , Canzanella Sergio , Florio S. , Landolfi Vincenzo 
Published: February 2017

218 Background: We have evaluated the treatment procedures and the clinical outcome in terms of pain control on 163 consecutive patients enrolled from December 2012 to April 2014 at “Pain Control Center” of the Hospice of Solofra. Methods: The following characteristics have been evaluated: patient gender, mean hospitalization time, differentiation between cancer and non cancer patients (pt.), tumour type, medical weapon use, venous access type, parenteral feeding, transfer in intensive care units, pain killer use. Results: Of the 163 patients (96 males and 67 females, mean age 63.31 years, range: 31-90 years, mean hospitalization time: 29.85 days) 126/163 pt (77.30%) had tumour diseases and 37/163 pt. (22.69%) non cancer diseases. Cancer pt. had lung (24.6%), colo-rectal (17.46%), breast (4.76%), bladder (5.55%), gastric (5.55%), prostate (3.17), hepatocellular (4.76%), pancreas (3.96%), head and neck (4.76%), kidney (3.17%) and other site tumours (19.67%). Patients with tracheostomy were 14/163 (8.58%), with gastrostomy 11/163 (6.74%), with uretero and colostomy 21/163 (12.88%) and with active mechanical ventilator 5/163 (3.06%). The central venous accesses were already present at the moment of the hospitalization in 61/163 pt. (37.42%); during the hospitalization the central venous access were made on 48/163 (29.44%). Seventy-six out of 163 pt. (46.62%) received either total or partial parenteral feeding while 26/163 pt. (15.95%) received enteral feeding. Analgesic therapy with opioids was administered at 131/163 pt. (80.36%) as it follows: morphin in 18.32%; oxycodon/naloxon in 23.63%; codein-paracetamol in 9.16% and transdermic or transmucosal Fentanyl in 48.85% of the pt. The most intensively treated pts. were those with tracheostomy followed by uretero and colostomy. Conclusions: The results of the present study confirm the underestimation of the parenteral feeding and analgesic requirements by pts. with chronic diseases. Another interesting result of the present report is the good clinical benefit achieved with the use of oxycodon/naloxon associated or not with other pain killers. These results are on line with the guidelines that suggest the use of oral slow release opioids.
Social and emotional factors and decisions of advanced cancer patients (ACP) to enter an early-phase (EP) clinical trial.
Authors: Dohan Daniel Paul , Wiley James , Garrett Sarah B. , Trupin Laura , Hlubocky Fay J. , Daugherty Christopher , Reinert Anne , Munster Pamela N. 
Published: February 2017

223 Background: We explored how social and emotional factors shaped decisions by ACP to enter an EP trial. Methods: Mixed-methods longitudinal cohort study including validated surveys and open-ended interviews. ACP were recruited at an academic medical center with an EP trials program. Patients were eligible if treating oncologists deemed them likely to exhaust standard treatment in 6-12 months but before being offered EP study enrollment. Surveys measured symptoms, quality of life, decisional preferences, emotions, and demographics. 60 minute semi-structured interviews were audio recorded and transcribed. SAS (statistical) and Atlas.ti (thematic coding) were use for analysis. Results: Of 82 patients in the ACP cohort, 16% went on to initiate EP trial entry. No social and emotional factors were associated with EP initiation except ACP who reported both not “feeling down” and feeling “in control of things in your life” (Table) were more likely to initiate. In interviews, many EP initiates expressed hopefulness and a desire to actively respond to their illness. While none believed they could control their illness, some ACP attributed their sense of control over things to their relationship with their oncologist, and others attributed it to informational networks. Conclusions: A feeling of control and absence of depressive symptoms may be associated with ACP initiation of an EP trial. Further exploration of qualitative data documenting the dynamics of EP decision-making is needed. [Table: see text]
Impact of NCCN distress thermometer screening at new patient oncology visits in a large community cancer institute.
Authors: Sivendran Shanthi , Roda Patti , De la Torre Kristen , Newport Kristina Braine 
Published: February 2017

226 Background: Psychosocial distress can impact a patient’s quality of life and potentially impact timely and effective cancer management. The National Comprehensive Cancer Network (NCCN) developed a distress thermometer that includes a ten point scale of distress and checklist of psychosocial issues. In this analysis we compare rates of referrals to our support services prior to and post implementation of this tool in our community oncology practice. Methods: Data one year prior to and post implementation of the NCCN distress thermometer was retrospectively reviewed. The tool was implemented in July 2013 and administered to the patients by our clinical staff at the patient’s first visit. Based on this tool, the clinical staff offered referrals to social work, chaplaincy, nutrition, or financial counseling. Re-education on administration of this tool occurred in January 2014. In this study we compare support service referrals pre and post NCCN distress screening implementation and staff education. Results: From July 2012 to June 2013, 829 referrals were made to support services. Specifically, 39% of these referrals were to social work, 19% to chaplaincy, and 38% to nutrition. From July 2013 to May 2014, 1434 referrals were made to support services. Specifically, 37% of these referrals were to social work, 10% to chaplaincy, 20% to nutrition, and 34% to financial counseling. Referrals to social work were most impacted by implementation of the NCCN distress screening with a median increase from 26.5 (range 14-45) to 45 (range 32-68). Referrals to other support services were not impacted. Referrals to financial counseling were most impacted by the re-education process with a median increase from 38 (range 28-42) to 53 (range 42-58). Conclusions: Implementation of the NCCN distress thermometer allowed better identification of patients for social work and financial counseling interventions. This tool was less effective at increasing referrals to nutrition and chaplaincy. The need for these services may be better captured during the treatment period. Future investigation into this may include application of the distress tool during subsequent patient visits.
Evaluation of an online, skill-building, group intervention for patients with cancer: Pillars4Life.
Authors: O'Donnell Jonathan David , Abernethy Amy Pickar , Samsa Greg , Staley Tina , MacDermott Kristin , Smith Sophia 
Published: February 2017

239 Background: Psychosocial distress is common for those with cancer; new interventions are needed. Pillars4Life is an online educational program that teaches coping skills in a group format. What is the relationship between participation in the LiveStrong-funded Pillars4Life program and personal psychosocial outcomes? Methods: This was a longitudinal observational cohort study. Cancer patients participating in the Pillars4Life program were recruited from the 17 hospitals that received the LiveStrong Community Impact Award. Consenting participants participated in 10 weekly sessions and completed electronic surveys at baseline and 3 months. Patient reported measures included: distress [Distress Thermometer (DT), Patient Care Monitor (PCM)], depression [Patient Health Questionnaire 9 (PHQ9)], anxiety [Generalized Anxiety Disorder 7 (GAD7)], posttraumatic stress [PTSD Checklist-Civilian (PCLC)], despair (PCM), fatigue [Functional Assessment of Chronic Illness Therapy (FACIT)], and cancer-related wellbeing [Functional Assessment of Cancer Therapy-General (FACTG)] outcomes. Results: Patient participants (n=130) were: mean age 56±11 years; 87% female; 89% white; 61% married; 48% employed; 51% had breast cancer; and 63% were receiving treatment. Mean scores significantly improved from baseline to month 3 on all patient-reported outcome measures: DT (-0.9), PCM Distress (-3.0), PHQ9 (-2.3), GAD7 (-2.3), PCLC (-4.3), PCM Despair (-2.9), FACT-G (4.7), all p<.001; and FACIT-Fatigue (3.3, p=.001). Patients who reported distress at baseline (DT≥4; n=70) had clinically significant improvements (moderate to strong effect sizes ranged from 0.5 to 1.0 standard deviation units) in DT; PCM Distress, Quality of Life, and Despair; PHQ9; GAD7; PCLC; FACTG, among others. Conclusions: Participation in Pillars4Life was associated with statistically and clinically significant improvements on key psychosocial and quality of life patient-reported outcomes measures. Importantly, distressed patients experienced meaningful improvement.
Initial experience with an innovative pilot program evaluating a multidisciplinary approach to supportive care planning in a survivorship clinic setting.
Authors: Radice Lisa M. , Eagan Jeffrey , Michie Kathleen Y. , Pearson Marianne , Petit Joshua H. 
Published: February 2017

242 Background: The supportive care and rehabilitative needs of cancer patients are highly varied and complex, and optimal care planning often requires the provision and coordination of multiple modalities. To address these needs, an innovative model for multi-disciplinary evaluation and management within a survivorship clinic was piloted. Methods: Between November 2013 and May 2014, 50 patients who had completed cancer therapy with curative intent were seen in a multi-disciplinary survivorship clinic (MDSC) sequentially by an advanced practice practitioner (nurse practitioner or physician assistant), oncology social worker, and oncology rehabilitation therapist. Data regarding specific care planning resulting from this encounter, compliance with recommended therapies, and patient-reported satisfaction were collected. These data were compared against the remaining cohort of patients (N = 402) who completed curative intent cancer therapy in our cancer program during the same period. Results: Rate of referral for rehabilitation services (83.3% vs 13.9%, p < 0.01) and compliance with recommended therapy visits (85.7% vs 44.6%, p < 0.01) were significantly increased among patients seen within the MDSC pilot when compared with similar patients who were not seen in this setting. The number of referred therapy modalities was also increased among patients seen in the MDSC pilot, median 2 (range 1-3 modalities) vs 1 (range 1-2 modalities), respectively. Of patients who completed an assessment following the multi-disciplinary visit, 86% scored their overall experience as excellent which was the highest possible score. Conclusions: Patients seen within an innovative pilot program of multi-disciplinary survivorship care planning appreciated increased rates of referral for rehabilitation services, were referred for a greater number of therapy modalities, and were more compliant with recommended interventions than similar patients who were not seen in this setting. This patient cohort also reported high rates of satisfaction with the pilot program.
Utilization of single-fraction radiotherapy for the treatment of bone metastases before and after the “Choosing Wisely” campaign.
Authors: Curry Heather A , Forastiere Arlene A. , Flood William A. , Whyler Elaine , Hertan Lauren Michelle , Sharma Sonam , Jones Joshua Adam 
Published: February 2017

245 Background: Multiple studies have demonstrated equivalence of single vs. multi-fraction regimens for palliation of uncomplicated bone metastases, but single fraction (SF) radiotherapy (RT) remains under-utilized in the United States. To increase physician and patient awareness of RT options for bone metastases, both AAHPM and ASTRO participated in the “Choosing Wisely” campaign. AAHPM recommended 8 Gy X 1 for uncomplicated bone metastases. ASTRO recommended against routine use of courses > 10 fractions and supported strong consideration for the use of SF RT for patients with limited prognosis or transportation difficulties. To identify possible changes in prescribing patterns following “Choosing Wisely”, we evaluated utilization rates of SF (8 Gy x 1) for treatment of bone metastases via treatment requests submitted for preauthorization over a 3 year period. Methods: A proprietary web-based application (eviti Connect ) enables oncology providers to obtain real time automated precertification for patients insured by payers across the U.S. that utilize the platform. All preauthorization requests for RT of bone metastases were evaluated for the prescription of 8 Gy X 1. The overall rate of SF use was calculated as were quarterly rates within the study period. Results: From 6/1/11-6/30/14 7,524 requests were submitted; 658 were for bone metastases. Overall SF was used in 7.6 % of cases. Prior to Q4 of 2012 no prescriptions for 8 Gy X 1 were used. In 2013 SF was prescribed in 9.6% of cases (30/314): 2.8%, 7.3%, 7% and 20% for Q1, Q2, Q3, and Q4 respectively. During 2014 use of 8 Gy X 1 was 23.9% in Q1 and 19.5% in Q2. Protracted schedules > 10 treatments were prescribed in 31% of cases, but decreased over the study period (from 40% prior to Q4 2012, to 28% in 2013, and to 23% in the first half of 2014). Conclusions: Within this unique dataset of working aged insured patients, utilization of 8 Gy X 1 for treatment of bone metastases has increased. Increases were most pronounced in 2013. This coincides with the announcement and dissemination of the “Choosing Wisely” initiatives. Longer follow-up is needed to determine if increased provider uptake of SF RT as a componant of patient-centered quality care persists.
Health care quality experiences among cancer survivors in the United States, 2011.
Authors: Bell Janice , Whitney Robin L. , Reed Sarah , Davis Andra , Kim Katherine , Copenhaver David , Bold Richard J. , Joseph Jill G. 
Published: February 2017

246 Background: Recent national reports highlight gaps in the quality of health care received by the growing population of cancer survivors in the United States. A deeper understanding of the health care experiences of cancer survivors and related disparities could inform interventions designed to address these gaps. Methods: Data from the 2011 Medical Expenditures Panel Survey Household Component and Experiences with Cancer Survivorship Supplement (n=1,592) were used to compare health care experiences of survivors those those of individuals in active treatment. Logistic regression models of three outcomes (receipt of necessary care; detailed discussions with providers about late or long-term side effects of cancer treatment; and detailed discussions with providers about lifestyle or health recommendations e.g., diet, exercise, quitting smoking) were controlled for potential confounding variables including age, sex, health insurance status, education, race/ethnicity, and marital status. Survey weights were applied to account for the complex sampling design and estimates are generalizable to the US civilian, non-institutionalized population. Results: Most respondents (96%), whether or not they were in active treatment, reported they had received all medical care, tests, or treatments that they or their providers believed were necessary. Fewer survivors, compared to respondents in active treatment, reported their providers had discussed late or long-term side effects (37% versus 61%; p<0.01) or lifestyle recommendations with them in detail (57% versus 72%). These associations persisted in the multivariable models of side effect discussions (OR=0.38; 95% CI: 0.26, 0.55) and lifestyle recommendations (OR=; 95% CI: 0.35, 0.68) regardless of the length of time since treatment had finished. Subgroups with lower odds of all three outcomes included those with public or no insurance and those with lower levels of education. Conclusions: Care received after treatment for cancer may not fully address the unique needs of cancer survivors and, in particular, those with public or no insurance and with low levels of education regardless of treatment status. Targeted interventions with a focus on these subgroups may be required.
Skeletal-related events (SREs) and survival among elderly patients with stage IV prostate cancer (PCa) in SEER Medicare data.
Authors: Onukwugha Ebere , Kwok Young , Yong Candice , Franey Christine , Mullins C. Daniel , Seal Brian S. , Valderrama Adriana , Hussain Arif 
Published: February 2017

249 Background: Skeletal-related events occurring among PCa patients with bone metastasis include radiation to the bone (RttB), pathological fracture, spinal cord compression (SCC), and bone surgery (BS). There is no validated algorithm for identifying RttB using claims data. We investigated the prevalence and mortality impact of SREs across alternative claims-based algorithms for identifying RttB. Methods: We analyzed data for stage IV PCa cases identified between 2005 and 2009 in the Surveillance, Epidemiology, and End Results registry linked with Medicare claims. Fracture, SCC, and BS were identified from claims. Focusing on external beam radiation therapy, radiopharmaceutical therapy, intensity modulated radiotherapy and stereotactic radiosurgery, three approaches were created based on data visualization software: 1) radiation claim occurred after a claim with a bone metastasis (BM) code; 2) BM code directly coincided with the period of the radiation treatment episode; 3) either #2 or the duration of the radiation episode was less than or equal to 4 weeks. Regression models for all-cause mortality used these measures. Results: The study sample included 5,380 men with stage IV PCa. The median age of the sample was 77 years. All-cause mortality was 54% during median (mean) follow-up of 579 (656) days. The proportion who had any fracture, SCC, and BS was 23.2%, 6.3%, and 5.8%. Without taking BM code or duration of radiation into consideration, the proportion who received radiation therapy was 35%. Using approaches 1, 2 and 3 we have the following four results: 1) the proportion who received RttB was 22%, 18%, and 24%; 2) the prevalence of any SRE was 39%, 37%, and 41%; 3) among those with an SRE, the proportion receiving RttB was 57%, 50%, and 58%; 4) the adjusted hazard ratio (95% CI) associated with any SRE was 1.22 (1.13–1.33), 1.22 (1.12–1.33), and 1.25 (1.15–1.36). Conclusions: Among older men diagnosed with stage IV prostate cancer, approximately one in five men received palliative radiation and the mortality impact of skeletal-related events was comparable across alternative approaches to identifying palliative radiation.
The importance of communication about cachexia as experienced by patients and caregivers: A qualitative cross-cultural study.
Authors: Del Fabbro Egidio , Borneman Tami R. , Graffigna Guendalina , Cecchini Isabella 
Published: February 2017

37 Background: Cancer Anorexia-Cachexia Syndrome (CACS) is a multifactorial condition defined by an ongoing loss in body weight that cannot be fully reversed through conventional nutritional support and leads to progressive functional impairment. This condition has for a long time been misrecognized and underdiagnosed. Furthermore, the burden of CACS as experienced and depicted by patients and caregivers has not been deeply explored so far. Methods: This was a narrative qualitative cross-cultural study (IT, ES, UK, DE, US) based on the collection of 30 weekly emotional diaries followed by 30 semi-structured in-depth interviews to caregivers (i.e. relatives, partners, close friends) of patients diagnosed with CACS. The aim was to understand how the disease is experienced by patients and caregivers, their feelings and unmet needs. Results: Caregivers and patients demonstrate a poor knowledge of CACS: while they spontaneously refer to a pattern of CACS symptoms, they do not verbalize the term “cachexia”. The awareness and levels of engagement in managing CACS by caregivers appear to be dependent on the degree and timing of communication on this condition with the physician: those who express a higher sense of powerlessness and despair also report that their doctor has never explicitly mentioned CACS, nor indicated any strategies to manage it. On the other hand, those who appear more confident and engaged in managing CACS report a more detailed and earlier communication on the subject. Conclusions: Scarce and/or late communication on CACS and its management options with patients and caregivers may result in a sense of powerlessness and ignorance on how to manage its symptoms. In line with the recently reported importance of an early CACS recognition [(Aapro M et al, Ann Oncol (2014). 2014 May 2)], an earlier and thorough discussion about CACS with patients and caregivers would improve their level of engagement and help relieve some of their distress.
Feasibility of outpatient palliative care for oncology patients within the safety net.
Authors: Harris Heather A. , Kinderman Anne , Kerr Kathleen 
Published: February 2017

38 Background: Palliative care (PC) combined with standard oncology care has been shown to improve patient outcomes and reduce health care costs. In safety-net systems, where limited resources mandate containing costs across settings, outpatient PC (OP PC) could be an important tool for improving quality while lowering costs. Multiple studies have shown that oncology patients cared for in safety net systems often present very late in the course of illness, raising concerns about the proportion of patients who could be referred to an OP PC clinic. To address this question we analyzed utilization patterns among cancer patients cared for at our facility to examine the need for and expected net costs of an OP PC service. Methods: Retrospective cohort study of oncology patients cared for at an urban, safety-net hospital who died between July 2010 and June 2013. We used cancer registry data to identify decedents and claims data to evaluate utilization patterns and cost of care in the final 6 months of life. Results: Among the 403 cancer patients who died in the study period we found heavy, late utilization of inpatient (IP) services: 307 (76%) were admitted to the hospital in the 6 months preceding death, 45% in the final month of life. One third of patients died in the hospital and another 4% died within 3 days of hospital discharge. Direct costs per admission averaged $22,275. While late presentation was common, 133 (33%) patients had multiple health system encounters 91-180 days prior to death: early enough to be referred to an OP PC clinic. We modeled clinic costs assuming an annual volume of 50 patients, to be followed monthly for the last 4 months of life by a physician-nurse-social worker team. Annual staffing costs were estimated at $88,290. Prior research has shown that utilization of IP services in the final month of life is 40% lower amongst patients who receive early OP PC. Using that value, we estimated that providing OP PC to 50 patients annually would avoid 38 hospitalizations, with resulting avoided direct costs of $846,450. Conclusions: This feasibility study reveals that OP PC in the safety net can provide substantial return on investment, even if such services are only used by a subset of oncology patients who present earlier in their disease course.