bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluation of an advanced practice radiation therapist role in palliative radiation therapy.
Authors: Job Mary , Holt Tanya 
Published: February 2017

136 Background: To evaluate the impact a new Advanced Practice Palliative Radiation Therapist (APRT) role had on patients treated with palliative intent, with respect to reducing time from referral to treatment. To evaluate the technical ability of the APRT to delineate palliative field borders on digitally reconstructed radiographs (DRR) compared to the treating Radiation Oncologist (RO). Methods: The time in working days from referral to treatment and referral to planning was recorded for all palliative patients having 10 fractions or less. The patients were classified into two groups. Patients from G1 were referred to one of four selected ROs or directly to the APRT. All clinical and technical elements of their radiotherapy treatment were managed by the APRT. Patients from G2 were referred to one of the remaining four ROs in the department and had their radiation therapy treatment managed through the standard pathway. The APRT delineated field borders on all patients in G1, blinded to the ROs field delineation. The RO then deemed the APRTs field placement acceptable or unacceptable. If unacceptable the RO documented the reasons for rejection. Results: Over 5 months, data was collected on 150 palliative patients. The APRT managed 94 patients. The remaining 56 patients were processed through the standard pathway. The APRT delineated 90 palliative fields on patients blinded to the RO. Of these, 89% were deemed acceptable by the RO. Conclusions: There has been a positive impact with respect to reducing time from referral to treatment for patients receiving palliative radiotherapy with the introduction of the APRT role in palliative radiotherapy.[Table: see text]
Integration of palliative care for patients with solid tumors on phase I clinical trials.
Authors: Ferrell Betty R. , Chung Vincent M. , Koczywas Marianna , Williams Anna Cathy , Hurria Arti , Borneman Tami R. , Cooper Rhonda , Knight Louise , Fischer Patricia , Gallagher Denise , Smith Thomas J. 
Published: February 2017

138 Background: Cancer patients receiving Phase I clinical trials are a population with advanced disease, high symptom burden, and with multiple QOL concerns including use of advance directives. Methods: An NCI funded R01 is currently in progress (2014-2019) as a randomized clinical trial to test a palliative care intervention (PCI) in this population. The PCI includes comprehensive patient assessment, goals of care communication, interdisciplinary care planning and patient teaching. Aims and hypotheses test the impact of the PCI on symptoms, QOL, resource use, spirituality and distress. Outcomes for the study (N = 400) will be conducted at the conclusion of the RCT. This paper reports preliminary baseline data of the first 100 subjects accrued. Results: Subjects mean age was 59 years and 59% were female, similar to prior trials. Forty eight percent (48%) were ethnic minorities, higher than prior trials (3% non-white, Finlay E, 2014; 9%, Parsons JA, et al. PLoS One 2012) with colon (22%) and lung (21%) cancers as dominant. Patients had a mean of 2 comorbidities (range 0-8) and 40% of the patients are > 65 years of age. The most common symptoms reported by PRO-CTCAE (1 = least to 5 = most concern) were sexuality (4.2), fatigue (2.9), pain (2.6) and anxiety (2.5). Psychological Distress Thermometer, (0 - least to 10 = most distress) mean score was 4. FACIT spiritual concerns (1 = least to 5 = most concerning) identified greatest concerns of illness strengthening faith (2.0), strength from faith (2.0) and sense of harmony (2.6). There was limited use of supportive care services, PC consultation, or advanced directives. Conclusions: The population of Phase I trial patients is an important group for palliative care integration with major unmet needs in symptom management and advance care planning.
Multidisciplinary tumor board for improvement of oncology collaboration in advanced cancer patients.
Authors: Chang Sanders , Doshi Amish , Smith Cardinale B. , Scarborough Bethann , Serban Stelian , Ciccone Jeffrey , Dharmarajan Kavita Vyas 
Published: February 2017

175 Background: The Palliative and Supportive Oncology Tumor Board was developed in 2015 to provide an interdisciplinary forum for discussion and management of patients with complex or refractory symptoms from advanced cancer. The board meets monthly and consists of medical, surgical, and radiation oncologists, interventional radiologists, pain management, palliative care specialists, residents, and fellows. Here, we assess the impact of the tumor board on the care of these patients. Methods: Electronic records of advanced cancer patients discussed at the tumor board from January 2015 to December 2015 were analyzed. We extracted data regarding sociodemographics, primary cancer site, pain interventions delivered, palliative care services utilized, and readmissions. Results: Thirty-two patients were presented at the tumor board over twelve months. The median age was 60 years (range 26-89); 47% were male. Primary cancer site included multiple myeloma (n = 11), gastrointestinal (n = 9), genitourinary (n = 5), breast (n = 2), lung (n = 2), skin (n = 1), and unknown origin (n = 2). At the time of discussion, 16 patients were hospitalized and 18 were in the ambulatory setting. Recommendations from the tumor board included altering medication regimen (n = 4), discussing eligibility to receive an anesthetic block (n = 7), undergoing vertebroplasty (n = 9), and planning palliative radiation treatment (n = 19). Patients were seen by specialists from pain (n = 21), interventional radiology (n = 14), neurosurgery (n = 9), palliative care (n = 20), radiation oncology (n = 21), or medical oncology (n= 32) within one day of their case presentation at the tumor board. Seven patients were transferred to the inpatient palliative care unit within a day of their tumor board discussion. Five patients were readmitted to the hospital within 30 days due to uncontrolled pain or other symptoms. Conclusions: The palliative and supportive oncology tumor board was well received by clinicians overall. It fostered interdisciplinary collaboration and supported comprehensive management of pain and other symptoms, as evidenced by the mix of cases discussed and the short time within which patients were seen after presentation by the participating specialists.
Provider perceptions of burnout while engaging in end-of-life care conversations: A pilot study using the Serious Illness Conversation Guide.
Authors: Beck Anna Catherine , Miraglia Allison , Rajeev Deepthi , Hanover Rita , Steenstra Joshua , Talebreza Shaida , Martinez Holli , Looney Emily 
Published: February 2017

19 Background: Studies recommend improved attention to patient end-of-life (EOL) care preferences and there is evidence that effective provider-patient EOL care conversations yield positive patient outcomes and reduce stress, anxiety, and depression for providers. Providers lack training to elicit patients’ EOL care goals and hence are reluctant to initiate EOL conversations. Methods: The Serious Illness Conversation Guide (SICG) was used to train providers and data were collected based on the Maslach Burnout Inventory to assess provider burnout, determine satisfaction of SICG training, and change in confidence/knowledge related to EOL conversations. Results: 18 providers were trained with a median work experience of 15 years. 41% spent 8+ hours/week interacting with seriously ill patients, 50% initiate EOL conversations < twice/month, and 19% reported burnout. 10 providers responded to the post-training evaluation, 80% reported burnout (Table). Conclusions: Providers reported high satisfaction of SICG training and increased knowledge and confidence related to EOL care conversations. However, provider burnout increased, possibly due to their increased awareness of an appropriate way to elicit patients’ EOL care goals. To explore this further, we will be conducting additional training sessions in the future. [Table: see text]
Investigating high-concentration 8% capsaicin patch in chronic cancer-treatment related peripheral neuropathic pain.
Authors: Ramnarine Sabrina , Laird Barry , Williams Linda J , Fallon Marie T 
Published: February 2017

208 Background: Cancer-treatment related peripheral neuropathic pain is a challenging clinical problem as current interventions have limited efficacy and significant toxicities. This study aims to examine the analgesic effect of high-concentration 8% capsaicin patch in this cohort of patients. Methods: A single arm study was conducted. Patients with long-term peripheral neuropathic pain received a single application of 8% transdermal capsaicin patch to the affected area (chest wall, hands or feet). Assessments at baseline, 4 weeks and 12 weeks post-treatment included: Brief Pain Inventory (BPI) short form (pain severity and interference with function); Hospital Anxiety and Depression Scale (HADS). The primary efficacy measure was a clinically significant improvement in pain (≥ 30% reduction in total BPI score (responders) from baseline to 4 weeks and 12 weeks). Secondary efficacy measures assessed worst pain, function and associated changes in mood. Results: 19 patients, median age 61.5 all had peripheral neuropathic pain for a median of 2 years (IQR 1-3) following treatment for various types of cancer: gynecological (n = 2), breast (n = 6), colorectal (n = 8), multiple myeloma (n = 2) or other (n = 1). At 4 weeks, 37% (7/19) patients showed a clinically significant improvement in pain (≥ 30%). Of the 7 responders, 5 had > 50% reduction in pain. 16% (3/19) suggested a partial improvement (mean 17%). Of the patients reassessed at 12 weeks, 50% (7/14) were responders with all patients exhibiting a reduction in: worst pain score, -1.3 (95% CI: -2.5, -0.06; p = 0.04), interference with function, -10.9 (95% CI: -21.5, -0.4; p = 0.04) and HADS depression score, -1.7 (95% CI: -3.4, 0.02; p = 0.05). Total HADS score correlated with total BPI at 4 weeks (r = 0.68) and 12 weeks (r = 0.70). HADS depression score also correlated with BPI at 12 weeks (r = 0.73). All correlations were significant (p < 0.01). Conclusions: In patients with chronic, resistant, cancer-treatment related peripheral neuropathic pain, high-concentration 8% capsaicin patch may provide some benefit in pain severity, function and mood with the effect continuing at 12 weeks post-treatment. This may warrant further long-term follow up in a larger cohort.
The elephant in the room: Facilitating conversations about advanced cancer between patients and their spouses.
Authors: Porter Laura S. , FIsh Laura , Uronis Hope Elizabeth , Zafar Yousuf , Steinhauser Karen E. 
Published: February 2017

233 Background: Interventions to enhance couples’ communication about cancer-related issues can lead to benefits for patients, spouses, and their relationships. We recently conducted a pilot study testing a couples communication skills training (CCST) intervention targeted to couples in which one partner had advanced GI cancer, a population who may need particular help addressing difficult and emotionally-laden topics related to life-limiting illness. Results of quantitative analyses suggested that the intervention was effective in improving relationship satisfaction for these couples. The objective of the current study was to analyze intervention session conversation content to identify themes that couples addressed spontaneously, with the ultimate goal of determining whether an intervention that more specifically guides couples to discuss issues related to end of life and the life-limiting nature of the patient’s illness would be acceptable. Methods: 12 couples (10 male and 2 female patients and their spouses) completed the 6 session CCST intervention which provided training in communication skills for sharing thoughts and feelings and making decisions, and gave couples the opportunity to use these skills to discuss cancer-related issues of their choosing. We conducted qualitative content analysis of the 72 audio-recorded sessions, and coded common and recurrent topics raised by patients and spouses. In addition to identifying breadth of topics, we used theme frequency as an initial gauge of theme importance and acceptability. Results: The most common themes identified were prognosis, treatment, emotional intimacy, completion, spouse’s life after the death of the patient, roles, communication, sublimating needs, emotional support, and family. These represent themes previously identified as important to patients at end of life, as well as themes unique to dyads in intimate relationships. Conclusions: These findings support the feasibility of conducting an intervention that combines training in communication skills with guidance for using these skills to discuss topics that are potentially most meaningful to couples facing advanced illness.
Inpatient integrated palliative and transplant care to improve family caregiver (FC) outcomes of patients hospitalized for hematopoietic stem cell transplantation (HCT).
Authors: VanDusen Harry , LeBlanc Thomas William , Traeger Lara , Greer Joseph A. , Pirl William F. , Jackson Vicki A. , Telles Jason , Rhodes Alison , Chen Yi-Bin Albert , Temel Jennifer S. , El-Jawahri Areej 
Published: February 2017

235 Background: As their loved ones struggle physically and psychologically with transplant toxicities, FCs of patients undergoing HCT experience substantial distress. We assessed the impact of an inpatient palliative care intervention on FC quality of life (QOL) and mood during their loved ones’ HCT hospitalization. Methods: We conducted a randomized trial of inpatient palliative care integrated with transplant care versus transplant care alone for patients hospitalized for HCT and their FCs. Eligible FCs were identified as a relative or a friend with regular in-person contact with the patient and enrolled within 72 hours of the patient’s HCT admission. The intervention entailed at least twice weekly visits between the patient and palliative care during the transplant hospitalization, and FCs were welcome but not required to be present for these visits. We used the CareGiver Oncology QOL Questionnaire (CarGOQOL) to examine QOL, and the Hospital Anxiety and Depression Scale (HADS) to assess FC mood at baseline and week-2 during HCT hospitalization. We used the two-sample t-test to assess changes in QOL and mood from baseline to week-2. Results: We enrolled 160 patients and 94 (58.8%) FCs (control n = 49, intervention n = 45) between 8/2014 and 1/2016. Study groups did not differ significantly in baseline characteristics or overall FC QOL. At 2 weeks, FCs of patients randomized to the intervention reported improvements compared to those receiving transplant care alone in some QOL domains including better coping (0.23 vs. -0.74, p = 0.02) and handling of finances (0.24 vs. -0.46, p = 0.02) and also reported lower depression symptoms (HADS-Depression: 0.25 vs. 1.80, p = 0.03). No other CarGOQOL domains or HADS-anxiety symptoms were significantly different. Conclusions: Involvement of palliative care for patients hospitalized for HCT leads to improvement in FC depression and some aspects of their QOL. These findings demonstrate the positive impact of inpatient integrated palliative and transplant care extends to FCs of patients with hematologic malignancies undergoing HCT. Clinical trial information: NCT02207322.
Effect of red blood cell transfusions on patient-reported outcomes in an ambulatory oncology population.
Authors: Chen Lillian Jo-ann , Moeller Kimberly D , Wagman Lawrence David 
Published: February 2017

78 Background: The standard transfusion (Tf) trigger in the hospitalized patient is hemoglobin (Hgb) level driven. Triggers in the ambulatory oncology population are often symptom based. The symptoms of exercise intolerance (EI), fatigue (F), and shortness of breath (SOB) were identified from a hospital quality review. The purpose of this study was to evaluate patient reported symptom (SX) changes following red blood cell (RBC) Tf. Methods: Standardized Tf orders required symptom indication(s) which include EI, F, SOB and Other. After Tf, patients were asked to complete a telephone survey to evaluate symptom changes. Responses were recorded: same, better, or worse. Data collected: # of SX/patient, initial Hgb, days between Tf and survey, cancer diagnosis, # of units Tf, age and gender. Pre and post-Tf changes were calculated. p-values were obtained with binomial distribution, testing that the observed proportion of SX improvement was different from 50%. Results: From 12/2015 to 05/2016, 62 patients had 115 Tf episodes (TfE). M:F 30:32. Avg age: 72, (42-101). Avg Hgb 7.7 (3.4-9.9) Cancer diagnoses: MDS, breast, lung, colon, renal, prostate, gallbladder, rectal, gynecologic, myeloma, lymphoma, leukemia. 106/115 (92%) received 2 units of RBC per TfE. 35/115 (30%) were interviewed on post-TfE day 7 (4-14d). Fatigue (103 of 115, 90%) was the most common SX, Of the 115 TfE : 42/115 (37%) had 1 SX, 30/115 (26%) had 2 SX, 43/115 (37%) had 3 SX. Of the total TfE(155), 82 (71%) resulted in at least 1 SX improvement and in 33 (29%) there was no SX improvement, (p < 0.001). Conclusions: Fatigue, shortness of breath, and total reported symptom changes improved with Tf (statistically significant). The greatest improvement was seen in F followed by SOB. This unique analysis focuses on the ambulatory oncology patient. Reported symptoms can serve as a quality of life endpoint model to develop guidelines for RBC Tf not limited to Hgb levels. [Table: see text]
Prevalence of myofascial pain syndrome in patients with incurable cancer.
Authors: Ishiki Hiroto , Kinkawa Junya , Watanabe Aya , Watanabe Chie , Chiba Tsukuru , Shimada Naoki , Ariyoshi Keisuke , Nojima Masanori , Iwase Satoru , Tojo Arinobu 
Published: February 2017

97 Background: Myofascial pain syndrome (MPS) is a condition that involves skeletal muscles. It is caused by overload or disuse of muscles and is characterized by extreme tenderness in the muscles with taut bands. Treatment for MSP is different from that for cancer-related pain. Cancer patients have many factors that cause restriction of body movement and posture. Although cancer patients appear to demonstrate risk factors for MPS, its prevalence has not been reported in patients with incurable cancer. This study was conducted to investigate the prevalence of MPS in patients with incurable cancer. Methods: The data for patients with incurable cancer who received palliative care by our department between September 2015 and March 2016 were retrospectively investigated. We examined the prevalence of MPS. MPS was diagnosed on the basis of the Rivers criteria (RC) and Simons criteria (SC). We also examined the following factors associated with MPS: performance status (PS), use of medical devices (MD), and primary cancer sites. The primary outcome was the prevalence of MPS using the RC. Secondary outcomes included the prevalence of MPS using the SC, and the relationship between MPS and either PS or MD. Results: Thirty-four patients with incurable cancer were identified. The clinical characteristics are as follows: age (median, range): 65 (39-89) years; male/female ratio: 16/18; primary sites: pancreas (n = 8), breast (n = 8), lung (n = 4), colorectal (n = 4), head and neck (n = 2), and other primary sites (n = 8). Seventeen of 34 patients (50%) had a PS 3 or 4. Twenty-two patients (64.7%) complained of pain. MPS using the RC was detected in 10 patients (29%). MPS using the SC was detected in 20 patients (59%). Of 22 patients who complained of pain, MPS using the RC was detected in 10 (45%) patients and MPS using the SC was detected in 20 (90%) of patients. Patients with central venous port (CVP) devices had a significantly higher number of MPS lesions than patients without CVP devices (p = 0.029). Conclusions: A very high prevalence of MPS was detected in our study population. MPS should be considered when patients with incurable cancer complain of pain. A multi-center prospective study will be conducted to confirm our findings.
NRG Oncology RTOG 0415: A randomized phase III non-inferiority study comparing two fractionation schedules in patients with low-risk prostate cancer.
Authors: Lee W. Robert , Dignam James J. , Amin Mahul , Bruner Deborah , Low Daniel , Swanson Gregory P. , Shah Amit , D'Souza David , Michalski Jeff M. , Dayes Ian , Seaward Samantha A. , Hall William Adrian , Nguyen Paul L. , Pisansky Thomas Michael , Faria Sergio , Chen Yuhchyau , Koontz Bridget F. , Paulus Rebecca , Sandler Howard M. 
Published: February 2017

1 Background: To determine whether the efficacy of a hypofractionated (H) schedule is no worse than a conventional (C) schedule in men with low-risk prostate cancer. Methods: From April 2006 to December 2009, one thousand one hundred fifteen men with low-risk prostate cancer (clinical stage T1-2a, Gleason ≤ 6, PSA < 10) were randomly assigned 1:1 to a conventional (C) schedule (73.8 Gy in 41 fractions over 8.2 weeks) or to a hypofractionated (H) schedule (70 Gy in 28 fractions over 5.6 weeks). The trial was designed to establish with 90% power and alpha = 0.05 that (H) results in 5-year disease-free survival (DFS) that is not lower than (C) by more than 7% (hazard ratio (HR) < 1.52). Secondary endpoints include freedom from biochemical recurrence (FFBR) and overall survival. At the third planned interim analysis (July 2015), the NRG Oncology Data Monitoring Committee recommended that the results of the trial be reported. Results: One thousand one hundred and one protocol eligible men were randomized: 547 to C and 554 to H. Median follow-up is 5.9 years. Baseline characteristics are not different according to treatment arm. At the time of analysis 185 DFS events have been observed; 99 in the C arm and 86 in the H arm. The estimated 7-year disease-free survival is 75.6% (95% CI 70.3, 80.1) in the C arm and 81.8% (77.5, 85.3) in the H arm. The DFS HR (C/H) is 0.85 (0.64, 1.14). Comparison of biochemical recurrence (HR = 0.77, (0.51, 1.17)) and overall survival (HR = 0.95, (0.65, 1.41)) also met protocol non-inferiority criteria. Grade ≥ 3 GI toxicity is 3.0% (C) vs. 4.6% (H), Relative risk (RR) for H vs. C 1.53, (95% CI 0.86, 2.83); grade ≥ 3 GU toxicity is 4.5% (C) vs. 6.4% (H), RR = 1.43 (0.86,2.37). Conclusions: In men with low-risk prostate cancer, 70 Gy in 28 fractions over 5.6 weeks is non-inferior to 73.8 Gy in 41 fractions over 8.2 weeks. Clinical trial information: NCT00331773.