bluuebunny/crossref_metadata_2025_split huggingface dataset:
Program development through compilation of patient self-reported symptom burden.
Authors: Denny Diane , Bosch Brandon , Alston Kayla , Markman Maurie 
Published: February 2017

78 Background: Cancer Treatment Centers of America, (CTCA) is a national network of five hospitals that specialize in the treatment of patients fighting complex or advanced-stage cancer. The Symptom Inventory Tool (SIT) is an assessment tool that captures the patients’ perceived symptom burden for real time clinical intervention and provides longitudinal data to demonstrate how effectively we meet our patient’s needs, from the point of no intervention (baseline) and every 21 days or greater. The SIT is comprised of 27 questions utilizing the MD Anderson Symptom Inventory tool, a validated assessment instrument with 8 questions added and a free text box by CTCA. The SIT became an integral part of patient care at CTCA in September 2012. Methods: A multidisciplinary team convened to evaluate how best to deliver the SIT data to facility leadership to assist with program development. The data needed to perform each calculation was obtained using analytical software that interfaces the database, electronic health record, and cancer registry. A Quality Research Associate prepares the operational summary providing a monthly update for the leadership at each facility with data included for the previous month, cumulatively for the facility, and cumulatively for the network. Results: The summary includes mean time to complete an assessment, assessments by timeframe (i.e. baseline, 2nd, 3rd assessments, etc.), gender and age percentages, and patients categorized by cancer type. The top three average scoring symptoms and interference issues by baseline, 2nd, and 3rd assessment are highlighted along with the top areas of improvement and diminishment in score defined by a change of 2 or more points reflecting clinical relevance. The top areas scored at 8 or greater that improved and the top areas where patients continued to score at 8 or greater on return are presented to focus upon the most severe needs. Graphs and tables are accompanied by explanation. Conclusions: In addition to consistency in presentation of the data across centers, the SIT operational summary provides visibility and insight on key emerging trends. Meaningful discussion of programmatic opportunities for focus on the most problematic and severe symptom by patient group has occurred.
ASCO research program quality assessment tool: Basics for a quality community-based research site.
Authors: Hurley Patricia A. , Smith Renee Yvonne , Robert Nicholas J. 
Published: February 2017

97 Background: In 2008, ASCO published a statement to identify minimum standards and exemplary attributes of clinical trial sites. Recommendations were made to assist with the development and implementation of high-quality research programs. Based on feedback from an ASCO needs assessment survey, ASCO’s Community Research Forum (CRF) sought to develop a tool to help community-based research sites exceed the minimum standards of conducting clinical research, and to identify important components for an internal quality assurance program. Methods: A tool was developed to incorporate elements of ASCO publications on minimal standards and exemplary attributes of research sites. The tool was designed to assist community-based research sites with the development and implementation of an internal quality assurance program. A checklist was also developed to help sites easily conduct an assessment of their program. Community-based researchers provided feedback on the tool’s content and utilization. Feedback was incorporated and the tool was released for widespread use in March 2014. Results: The tool was very well received by reviewers. All reviewers indicated that the level of detail of the tool was sufficient; 94% indicated that it presented realistic expectations, in terms of resources required to implement; and 81% indicated that it would be valuable for conducting a quality assessment of their research program. As of July 2014, the tool was downloaded by over 150 practices from 8 different countries and early feedback continued to be favorable, particularly from small and/or new research programs. Conclusions: Many community-based research programs do not have the resources to support an effective quality assurance program and rely heavily on external audits. The ASCO Research Program Quality Assessment Tool provides self-directed continual process improvement to help community-based research sites create an internal quality assurance program and exceed minimum standards of conducting clinical research. The CRF will learn more from users of the tool about the quality of research programs and processes, and key quality metrics. The tool is available for download at www.asco.org/communityresearchforum.
Frequency and characteristics of cancer-related drowsiness (CRD or excessive daytime sleepiness) in patients with advanced cancer: Results of a prospective survey at a tertiary cancer center.
Authors: Yennu Sriram , Balachandran Dave , Pedraza Sandra L. , Berg Elyssa A , Chisholm Gary B. , Reddy Akhila Sunkepally , Williams Janet L. , Bruera Eduardo 
Published: February 2017

131 Background: CRD is extremely distressing but treatable symptom to the advanced cancer patients (ACP). There are limited studies to evaluate the frequency and characteristics of CRD. The aim of this study was to identify the frequency, and factors associated with severity of CRD. Secondary aim was to determine the screening performance Edmonton Symptom Assessment Scale (ESAS)-drowsiness item against the Epworth Sleepiness Scale (ESS). Methods: We prospectively assessed 180 consecutive ACP at a tertiary cancer hospital. After obtaining signed consent, the patients completed ESAS, Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI); ESS (≥10 diagnostic of CRD), Hospital Anxiety Depression Scale (HADS), STOP-Bang Screening Scale (SBS), and Screening tool for RLS. We determined epidemiological performance, spearman correlations, regression analysis, receiver operated characteristics of CRD. Results: Of the180 patients assessed, 51% were female, CRD was found in 50% ACP, median scores(IQR) ESS: 11(7-14); ESAS- drowsiness item was 5 (2-6); PSQI was 8(5-11); ISI (13 (5-19); SBS 3(2-4); HADS-D 6(3-10). Sleep apnea was found in 61%; and RLS in 38%. ESAS-D was associated with other ESAS items[r, p-value] Sleep (0.38, < 0.0001); pain (0.3, < 0.0001); fatigue(0.51, < 0.0001); depression(0.39, < 0.0001); anxiety(0.44, < 0.0001); shortness of breath(0.32, < 0.0001); anorexia(0.36, < 0.0001), FWB(0.41, < 0.0001), and ESS (0.24, 0.001), Opioid dose [MEDD] (0.19, 0.01). Multivariate analysis found no independent predictors except ISI (OR 2.35; 0.036), ESAS Fatigue (OR 9.08, <0.0001), ESAS Anxiety (3.0, 0.009); feeling of well-being (OR 2.27, p=0.04). An ESAS- drowsiness cut-off score of ≥ 3(of 10) resulted in a sensitivity and specificity of 81% and 32% and of 70% and 44% in the training and validation samples, respectively. Conclusions: Clinically significant CRD was associated with increased fatigue, anxiety, sleep disturbance and worse feeling of well-being. These symptoms should be routinely assessed and treated in ACP with CRD. ESAS-drowsiness score of ≥3 of 10 is most useful for screening CRD.
Sequencing the genome of hope.
Authors: Ferguson Anna K. , Lipson Evan J. 
Published: February 2017

234 Background: Hope is widely regarded as essential to the emotional health of cancer pts, yet remains under-studied. We sought to explore the concept of hope and develop a teaching module to educate providers about the importance of hope in optimizing oncology care. Methods: We audio recorded interviews with oncology patients. Questions focused on what hope means, the role it plays in their ability to manage their illness, and ways in which they felt oncology providers could engender hope and positively impact their experience. We also interviewed oncology providers, including physicians, nurses, and social workers. Questions focused on the role they feel hope plays for their pts, whether or not they have received training in how to discuss hope, and tools they use to discuss hope with their pts. Common themes were extracted to form the backbone of a webcast-style teaching module. Results: A total of 24 volunteers were enrolled in an IRB approved protocol. One half of the subjects were pts and the other half were oncology providers (n = 6 physicians, 3 nurses, 3 social workers). Hope emerged as an important element to good quality of life in 12/12 (100%) pts.. The overwhelming majority (11/12, 92%) further expressed that feeling “well cared for” as well as receiving clear, honest information about their disease greatly increased their hopefulness. Hope also was recognized as essential to pts’ wellness and ability to manage their illness by all 12 (100%) of the providers. Although all providers recognized hope as essential to their pts, only the social workers reported that they had received some level of training in how to discuss hope, while the physicians and nurses felt that they had received little to no training. All providers expressed desire to contribute positively to their pts’ sense of hope. Conclusions: Both pts and providers view hope as a vital element in how oncology pts manage their illness. This point of connection between providers and their pts offers a mechanism to enhance the care of patients and impact their overall experience with cancer, yet most providers have little to no training in how to discuss hope. Development of an education module is underway to help increase awareness of the importance of hope and teach providers strategies to better engage with their pts on the subject of hope.
A retrospective analysis evaluating the benefit of early palliative care for patients with advanced pancreatic adenocarcinoma.
Authors: Quintin Julia , Bennouna Jaafar , Senellart Hélène , Hiret Sandrine , Barbarot Veronique 
Published: February 2017

30 Background: Patients with advanced pancreatic carcinoma exhibit from the diagnosis and beyond severe clinical symptoms dominated by pain and weight loss, hampering quality of life. A recent study in metastatic lung cancer have shown a clear advantage of early palliative care in both quality of life and mood (Temel JS, et al. N Engl J Med 2010;363:733-42). Methods: Based on these data, we conducted a monocentric retrospective study including patients with advanced pancreatic cancer newly diagnosed and treated according with standard guidelines. The aim of this study was to determine the contribution of early palliative care visits (with supportive care physicians) on disease control symptoms, quality of life and overall survival. Results: From January 2006 to December 2010, 157 patients, PS 0, 1 or 2, with newly diagnosis of advanced pancreatic cancer were retrospectively enrolled. 126 patients (80.3 %) received at least one chemotherapy line. Out of 157 patients, 64 (40.7%) were seen in our palliative care department. Demographic patient characteristics between the two groups were well balanced; palliative care versus non palliative care: median age, 66.2 vs 66.7 years; PS 0,1 51 (79.5 %) vs 73 (79.7 %) ; male 34 (53.1 %) vs 47 (50.5 %) ; metastatic disease 39 (60.9%) vs 51 (54.8 %). Patients in the palliative care group showed more clinical symptoms at diagnosis, especially pain (73.4% patients in palliative care group versus 50.5%; p=0.004). They received less aggressive care at the end of their life: interruption of chemotherapy earlier (1.7 months before death versus 1.2 months) and less number of chemotherapy cycles in the month before death (22.7% versus 43.5%, p=0.042). However, no significant difference was observed for overall survival between both groups: 7.5 months in palliative care group versus 6.9 months (p=0.99). Conclusions: This study underlines the need of a multidisciplinary approach in advanced pancreatic cancer, promoting palliative care started initially at the diagnosis. It deserves to be completed by a largest prospective randomized study including a quality of life analysis.
Delirium rate and risk factors in palliative oncology outpatients and associated caregiver coping.
Authors: Livermore Sarah Deur , Xavier Marin Feldman 
Published: February 2017

46 Background: Delirium causes suffering and undermines important palliative goals of care at end of life. Prior evaluation of outpatient delirium rate was 14% among demented elders. It is hypothesized that frail, palliative oncology outpatients have high rates of missed delirium. Improved knowledge and screening can improve patient outcomes through treatment in the home. This study examined the prevalence rate and risk factors for delirium among palliative care outpatients, and identified caregiver coping strategies associated with the episode. Methods: This was a descriptive, correlational study using a convenience sample of patient/caregiver dyads at an urban cancer center based on Rigney's Allopathic Load in Delirium Model. Oncology patient participants consented to a chart review for demographic risk factors. Caregivers of patients with a life-limiting illness were asked to complete two surveys at the time of their usual visit. The Family Administered Confusion Assessment Method, FAM-CAM scale reflected upon the patient's behavior over the past month using 12 simple yes/no questions. Risk factors such as age, gender, marital status, medications and diagnosis were correlated with delirium. The Folkman Lazarus Ways of Coping compared coping styles. Results: The rate of delirium among palliative care outpatients in this sample of 52 patient/caregiver dyads was 27%. The results suggested that opioid use slightly increases the odds for an episode of delirium, and approaches significance (r(50) =.270, p =.052). The majority of caregiver participants reported positive coping styles, however positive reappraisal and emotion-focused coping mechanism were more common in caregivers with a cognitively intact patient. Problem-focused coping was more common if the patient screened positive for delirium (m =.22, SD =.073). Conclusions: Oncology clinicians must screen for delirium in order to improve quality of care, especially among those on palliative chemotherapy.
Effect of early palliative care on depression and survival in patients with advanced cancer.
Authors: Prescott Anna Tekla , Hull Jay , Dionne-Odom J Nicholas , Lyons Kathleen , Tosteson Tor , Li Zhigang , Li Zhongze , Dragnev Konstantin H. , Bakitas Marie 
Published: February 2017

5 Background: We previously demonstrated improved depression and survival in advanced cancer patients participating in two palliative care (PC) RCTs: ENABLE II (EII; N=322) compared intervention vs. usual care, and ENABLE III (EIII; N=207) compared immediate vs. delayed intervention. The interventions were identical, except in EIII, the intervention included support for family caregivers and the delayed group began the intervention 12 weeks after enrollment. Both EII and EIII included an in-person PC consultation, weekly phone sessions facilitated by a nurse coach, and monthly follow-up calls. The Center for Epidemiologic Studies-Depression (CES-D) scale was collected at baseline and every 6 weeks until death or study completion. Our aim was to examine the moderating effects of baseline depression on the intervention effect and on survival outcomes in both RCTs. Methods: After combining data from the two RCTs the sample consisted of 529 patients. We conducted Cox proportional hazard analyses to examine the effect of the intervention (as a time-varying covariate) and baseline depression scores on subsequent survival. Results: The intervention significantly reduced mortality risk in this sample (Hazard Ratio [HR]= 0.78, CI: 0.63-0.98, p=.029). Adding baseline CES-D scores and the interaction of the intervention and CES-D scores as predictor variables yielded a significant interaction (HR= 0.97, p =.035) that remained after controlling for cancer type. Following this analysis, patients were classified as clinically depressed (baseline CES-D 16) or not, and Cox analyses were conducted using the intervention as the sole predictor within each depression group. Receiving the intervention significantly reduced mortality risk among clinically depressed patients (HR = 0.65, CI: 0.44-0.95, p =.029), but not among non-depressed patients (HR = 0.89, CI: 0.65-1.21, p >.45). Conclusions: The ENABLE intervention improved survival in this combined sample of advanced cancer patients. The intervention effect on survival was moderated by baseline depression levels, such that patients who were depressed at baseline and received the intervention had a longer survival compared with non-depressed intervention patients.
Impact of early palliative care consultation on inpatient length of stay and discharge disposition among oncology patients.
Authors: Dhakal Ajay , Shrestha Suvash , Homel Peter , Popp Beth 
Published: February 2017

53 Background: As palliative care develops as a medical subspecialty, studies are needed to assess its impact on patient care. Studies examining the effect of inpatient palliative care consult (PCC) on the admission length of stay (LOS) for non-ICU patients have failed to demonstrate consistent results. Also, there is a paucity of data on the effect of PCC on discharge disposition. The objective of this study is to examine the effect of early PCC on the length of stay and discharge disposition among cancer patients discharged alive. Methods: A retrospective review of oncology inpatients (pts) from January 2011 to Jan 2014 of whom 307 had PCC (PC group) and 305 pts did not have PCC (NC group). Visits less than 4 days, those ending with in-hospital deaths and those with PCC called more than 3 days into the admission were excluded. Groups were randomly matched based on All Patient Refined Diagnosis Related Group (APR DRG) Severity of Illness scores. Median LOS was compared with the Mann Whitney test. Pts coming from home without services (certified home health agency, advanced illness management, hospice, skilled nursing facility, or rehabilitation center) and discharged with services were considered favorable dispositions; any discharge without services was considered unfavorable disposition; all other dispositions considered neutral. Chi Square test was used to analyze discharge disposition. Results: The demographic profiles of 2 groups were similar in age, race, religion, marital status, insurance and living condition; females were more likely to get PCC (60 % vs 44 %, p<0.001). Median (minimum, maximum) LOS for PC group was longer by 1 day: 8 (4, 76) days vs 7 (4, 251) days for NC group (p=0.003). PC group was more likely to receive a favorable discharge disposition (45 % vs 36 %); less likely to receive unfavorable discharge (13 % vs 28 %, overall p < 0.001). Neutral dispositions were similar (41% vs 35 %). Conclusions: Oncology pts with PCC have 1 day longer LOS compared to those without it but are more likely to get a favorable discharge disposition. This may favorably impact readmission rates, which we hope to study in the future.
Early integration of palliative care in patients with pancreatic cancer: A retrospective study for quality improvement.
Authors: Grenon Nina N. 
Published: February 2017

72 Background: Many patients with pancreatic cancer receive palliative care only at the end of life despite the fact that the course of illness is plagued with physical, emotional symptoms and existential distress. There is strong evidence that combining palliative care with standard cancer treatment improves quality of life for those patients with in metastatic cancer and in some cases can help extend survival. Early incorporation of palliative care for patients with incurable cancer is an important focus for quality improvement. Methods: The purpose of this quality improvement study was to describe quality indicators for palliative care, and discover when palliative care was introduced during the course of illness in patients with pancreatic cancer. Domains of palliative care identified by the National Consensus Project and the National Quality Framework, provided the framework for this study. A retrospective medical record review of patients with pancreatic cancer treated at the Dana-Farber Cancer Institute (DFCI) between January 2009 to December 2011 was conducted. Time variables relevant to disease course, and palliative care referrals were collected. Other key variables included: the reason for, and frequency and timing of, palliative care discussions. Results: Medical records from 150 DFCI patients were reviewed in which the mean length of care from first visit to last note (typically death) was 414 days (SD=347). 52 (35%) records included documentation of a palliative care discussion and the majority of those occurred at the time of disease progression. Prognosis discussions were documented after a mean 177 (SD=285) days and a palliative care consult was made on average at day 343 (SD=301). Of those consults, the large majority (82%) were requested for symptom management. Conclusions: Despite evidence and standards of care that support early palliative care discussions and subsequent referrals for palliative care consults, these findings suggest such events occurred late in the trajectory and care of patients with pancreatic cancer. Future quality work and training will address provider and health system variables that can promote discussions and consults.
Oncogeriatrics joint consultations: When pharmacists improve patients' management together with oncogeriatrics physician.
Authors: Rey Jean-Baptiste , Parent Damien , Perin Stephane 
Published: February 2017

79 Background: Elderly patients often have several diseases and therefore polymedicated. Comorbidities and treatments may interfere with management of oncological patients. Methods: The objectives of this project are 1) to ensure a proper understanding of patients regarding their treatment, 2) to perform a pharmaceutical analysis of patients’ prescription, 3) to propose changes to the patients’ doctors (general practitioners and physicians of the Institute) to prevent and reduce adverse drug events. The project combines medical and pharmaceutical expertise around the patient to optimize their care coordinated with the action of a "disease professional” and a "drug professional " with a particularly vulnerable population. Results: Since the project began, more than 100 patients benefited from these joint consultations, thus establishing a network between the Institute and the general practionners supporting our patients. Optimization of drug treatment and reduction of iatrogenic events avoids the complications and hospitalizations extensions and / or re-hospitalization. The pharmaceutical intervention documented in the medical records of patients (explaining terms of the intervention) and the transmission of the report to "pharmaceutical consultation" to physician 1) improves the management of patients (reduction potential iatrogenic events – e.g. risk of falling by orthostatic hypotension) and 2) allows the referring physician to optimize patient care. Conclusions: Launched in 2010, the project entered its fourth year of existence and continues.