bluuebunny/crossref_metadata_2025_split huggingface dataset:
Site of death, place of care, and burdensome transitions among patients with advanced solid tumor malignancies or leukemia between 2000 and 2010.
Authors: Prsic Elizabeth Horn , Teno Joan M. , Gozalo Pedro 
Published: February 2017

144 Background: Early palliative care has been associated with improved outcomes in oncology patients. However, there is limited data on end-of-life (EOL) care in hematology patients over time. We describe site of death, place of care, and transitions at the EOL among leukemia and advanced solid tumor malignancy (ASTM) patients. Methods: Retrospective cohort study of fee-for-service Medicare beneficiaries 66 years and older who died in 2000 (n = 40,805) and 2010 (n = 43,547) with leukemia or advanced lung, colorectal, or pancreatic cancer. Based on Medicare billing data, we identified site of death, place of care, and burdensome transitions (BT). Examples of BT include multiple hospital admissions for expected complications, referral to hospice in the last 3 days of life (DOL), and EOL transfers. Results: The rate of acute hospital death decreased for leukemia and ASTM patients over time (adjusted rate decreases 8.4% in leukemia vs. 8.2% in ASTM, p < .001). However, acute hospital death was more likely in leukemia patients in 2010 (adjusted rates 35.8% vs. 19.0% in ASTM, p < .001). Intensive care unit (ICU) admission in the last 30 DOL increased in both groups, and was more likely in leukemia patients in 2010 (adjusted rates 34.2% vs. 23.4% in ASTM, p < .001). Transitions in the last 3 DOL increased over time, and occurred more frequently in leukemia patients compared to ASTM patients in 2010 (adjusted rates 24.5% vs. 19.0% in ASTM, p < .001). Multiple admissions for expected complications increased similarly for patients in both groups over time (adjusted rate increases 2.7% in leukemia vs. 2.9% in ASTM, p < .001). There was a striking increase in freestanding hospice inpatient unit care before death over time (increasing from 4.5% to 11.5% in leukemia and 7.5% to 15.9% in ASTM). Conclusions: Between 2000 and 2010, the rate of acute hospital death decreased in both leukemia and ASTM patients. However, there were increased rates of ICU and multiple admissions for expected complications in both groups, particularly in leukemia patients compared to ASTM patients. A similar increase was also observed in the use of freestanding hospice units before death for both groups.
Embedding palliative care into bone marrow transplantation clinic.
Authors: Noreika Danielle M , Cassel Brian , Noland Felicia , Del Fabbro Egidio 
Published: February 2017

157 Background: Stem cell/bone marrow transplantation (SC/BMT) is intensive therapy that creates the potential for a number of physical and emotional symptoms. Despite the symptom burden and support needs of these patients there are no publications describing palliative care involvement in the course of treatment. Methods: Retrospective chart review was performed on 37 patients followed over a 6-month period by a palliative care service embedded within the SC/BMT clinic. Results: 37 patients were referred by SC/BMT clinic physicians or nurses to a palliative care team embedded within the clinic (including a physician, physical therapist, and psychologist). Almost all patients were referred for symptom management rather than goals of care; only three (9%) died during the review period and for none of them was the reason for consultation goals of care/hospice referral. Patients were seen between once and eight times during the six month period by various members of the team. Most (77%) were allogenic transplant patients and most were seen within 6 months of their transplantation. The most common reasons for referral were fatigue (57%), anorexia (27%), pain (38%) and depression and/or anxiety (35%). At initial assessment the highest-rated symptoms were lack of appetite (mean 4.78, SD 3.08), fatigue (4.51 [2.59]), and diminished feeling of well-being (4.16, [2.51]). At initial assessment, 73% of patients had 3 or more different symptoms that they rated at 4+; this dropped to 39.1% at follow-up (n = 23). Of the 9 symptoms assessed at both initial and follow-up visits, 7 decreased significantly (all but fatigue and dyspnea) and none increased. For example appetite improved from 5.52 (2.98) to 3.13 (2.96); pain improved from 3.52 (2.92) to 1.78 (1.88) (n = 23, p < .01). SC/BMT providers requested an expansion of the service after three months of experience. Conclusions: Patients who have undergone SC/BMT experience many physical and emotional symptoms. Palliative care embedded within the bone marrow transplant clinic can provide benefit by lessening the symptomatic burden of patients.
Measuring the impact of integrating palliative care into a multidisciplinary brain and spine oncology clinic.
Authors: Manning Matthew , Larach Mary , Boyles Susan , Stern Abigail 
Published: February 2017

163 Background: Recent literature indicates that palliative care (PC) improves the outcomes of patients with cancer. Integration of PC providers into cancer centers is increasingly recognized to enhance symptom management with a beneficial effect on patient survival. In order to predict the impact of widespread PC integration, we hypothesized that a small pilot program may provide evidence supporting broader implementation. The current study endeavors to measure the result of adding a dedicated PC provider to a multidisciplinary brain and spine oncology program. Methods: Over the six month study period, a PC nurse practitioner was integrated into an existing weekly multidisciplinary brain and spine oncology conference and clinic. The provider participated in the multidisciplinary conference reviewing recent MRIs and discussing current disease status and treatment options. Following conference, the PC provider would consult on up to four of the clinic patients. Data were recorded regarding patient characteristics, goals of care, and changes in therapy. Results: The PC provider participated in 14 multidisciplinary clinics with a total of 180 subjects. Of those, 24 subjects met with the PC provider in formal consultation. The most common diagnoses were 41.6% with metastatic lung cancer and 25% with glioblastoma. For goals of care, an Advanced Directive discussion was documented in 100%. Do Not Resuscitate (DNR) orders were activated in 37.5% and documented in 54%. Medical Orders for Scope of Treatment (MOST) forms were introduced in 87.5% and completed in 25%. For changes in therapy, enrollment in hospice occurred in 33.3%. Pain medication was changed in 33.3%. Other symptoms including fatigue, weakness, anorexia, constipation, anxiety, lymphedema, dysphagia, depression, insomnia, and alopecia were managed in 87.5%. Conclusions: This study suggests that the integration of a PC provider into an existing multidisciplinary cancer program can produce a high rate of establishing goals of care and result in changes in treatment in a significant number of cases. Further study on the impact of integrating PC in cancer centers seems to be warranted.
Would women with breast cancer prefer to receive an antidepressant for anxiety or depression from their oncologist?
Authors: McFarland Daniel Curtis , Shen Megan Johnson , Harris Kirk , Tiersten Amy , Mandeli John , Holland Jimmie 
Published: February 2017

219 Background: Patient treatment preferences for the management of anxiety and depression influence adherence and treatment outcomes, yet breast cancer patient preferences for provider-specific pharmacologic management of anxiety and depression is unknown. This study examined breast cancer patients’ antidepressant prescriber preferences and their preferences for treatment by a mental health professional. Methods: Breast cancer patients (Stage 0-IV) were asked two questions: 1) “Would you be willing to have your oncologist treat your depression or anxiety with an antidepressant medication if you were to become depressed or anxious at any point during your treatment?”; and 2) “Would you prefer to be treated by a psychiatrist or mental health professional for problems with either anxiety or depression?” Additionally, the Distress Thermometer and Problem List, Hospital Anxiety and Depression Scale, Risky Families Questionnaire, and demographic information were assessed. Results: One hundred twenty-five participants completed the study. 60.4% were willing to accept an antidepressant from an oncologist and 26.3% preferred treatment by a mental health professional. 77.3% who were willing to receive an antidepressant from their oncologist reported either no preference or that treatment by a mental health professional didn’t matter (p = 0.01). Participants taking antidepressants (p = 0.02) or reporting high chronic stress (p = 0.03) preferred a mental health professional. Conclusions: The majority of patients accepted antidepressant prescribing by their oncologist; only a minority preferred treatment by a mental health professional. These findings suggest the benefit for promoting education of oncologists to assess psychological symptoms and manage anxiety and depression as a routine part of an outpatient visit.
Delivering more, earlier, and better goals-of-care conversations to seriously ill oncology patients.
Authors: Bernacki Rachelle , Paladino Joanna , Lamas Daniela , Hutchings Mathilde , Lakin Josh , Neville Bridget A. , Lipsitz Stuart R. , Gawande Atul , Block Susan 
Published: February 2017

39 Background: Patients with serious illness routinely receive treatments that are not aligned with their goals. Earlier clinical conversations about patients’ values and priorities lead to more goal-concordant care and improved quality of life, but these conversations often happen too late or not at all. The Serious Illness Care Program has designed a systematic approach to train and support clinicians in conducting more, earlier, and better conversations about goals of care with their patients. Objectives: Evaluate clinician adoption and acceptability of the training program and the Serious Illness Conversation Guide; determine the frequency, timing, and quality of goals of care documentation before death. Methods: Cluster-randomized trial including oncology clinicians and their patients. Intervention: clinician identification of high risk patients; 2½ hour clinician training on the Serious Illness Conversation Guide; email trigger/reminder; EMR documentation. Preliminary chart review to extract goals-of-care conversations for deceased patients in intervention and control. Results: 90 oncology clinicians: 47 intervention; 43 control. Of 47 intervention clinicians, 46 are trained and rate the training as effective (4.3/5). 97% of trained clinicians who have been triggered have adopted the Conversation Guide and find it acceptable (4.2/5). 342 patients enrolled: 176 intervention; 166 control; 38% have died (n = 131). A preliminary chart review revealed more goals-of-care conversations occurred before death in intervention compared to control (92% versus 70%, p = 0.0037); intervention conversations took place four months earlier than control (median 143 days versus 63 days, p = 0.0008). In addition, conversations were more patient centered (95% versus 45%, p < 0.001) and more readily retrievable in the EMR (68% versus 28%, p < 0.001). Conclusions: Preliminary data about the Serious Illness Care systematic approach demonstrate strong clinician adoption and acceptability. The intervention results in more, earlier, and better conversations about patient values and priorities, in addition to more patient-centered and retrievable documentation of goals of care in the medical record. Clinical trial information: NCT01786811.
Goals of care discussions and subsequent health care utilization among adults hospitalized for advanced incurable malignancy.
Authors: Buchanan Laurie , Tooze Janet , Klepin Heidi , Streer Nathan Paul 
Published: February 2017

46 Background: Patients with advanced cancer are at risk for repeated hospitalizations and aggressive therapy near the end of life. For these patients, an unscheduled hospitalization predicts survival of < 6 months and represents an opportunity to discuss goals of care which may decrease subsequent health care utilization. Our objective was to describe healthcare utilization for inpatients with advanced malignancies and investigate the association between goals-of-care discussion and subsequent healthcare utilization. Methods: We conducted a chart review of 100 patients with end-stage malignancies consecutively admitted to an academic medical center’s Oncology services beginning January 2013. Eligible patients had advanced incurable malignancy and an unscheduled admission. Exclusion criteria included hematologic malignancies, and hormone therapy responsive breast and prostate cancer. Descriptive statistics were used to characterize the population; variables were compared by code status using chi-square for categorical variables and t-tests for continuous variables. Results: Among 100 patients, the mean age was 62 (range 19-86), and 61% were male. Common cancer types were GI (32%) and lung (31%). Average # of lines of prior chemotherapy was 1.3 (SD 1.5), and 48% had received chemotherapy within 4 weeks of admission. Common reasons for admission were infection (25%), neurologic (13%), and pulmonary complaints (10%). During the hospitalization, 21% required an ICU setting; in-hospital mortality was 1%. Following discharge, 54% were readmitted to the hospital, and, of those patients, 56% spent time in an ICU. On the index admission, only 51% of patients had resuscitation preference documented which increased to 65% by discharge. The patients who had a discussion of code status while inpatient were more likely to be enrolled in hospice at discharge (40% vs. 0%, p < 0.0001) and had fewer readmissions following discharge (1.1 vs. 2.0 readmissions, p = 0.05). Conclusions: Patients with end-stage malignancies have high rates of healthcare utilization. Enhancing goals of care discussions during hospitalization may have a positive impact on readmissions and hospice enrollment.
A comparison of monthly symptom reports for older (≥ 70 years) versus younger (< 70 years) women with recurrent ovarian cancer over 1 year.
Authors: Thaker Premal H. , Sereika Susan M. , Arida Janet , Edwards Robert P. , Donovan Heidi 
Published: February 2017

85 Background: Approximately 30% of ovarian cancer patients are 70 or older at diagnosis. Evidence to guide treatment in this age group is limited in the recurrent setting due to clinician concerns about toxicities and quality of life. Evidence based on patient-reported outcomes is scarce. The objective of this exploratory analysis is to compare patient-reported symptoms for women with recurrent ovarian cancer > age 70 vs. < age 70. Methods: Ancillary analysis of data from a 3-arm web-based symptom management RCT (NR010735; GOG-259). Eligibility criteria included recurrent or persistent ovarian, fallopian, or primary peritoneal cancer; experiencing 3 or more cancer or treatment-related symptoms. 497 women were accrued; of those, 60 (12%) were > age 70. Monthly severity data for 11 cancer- and treatment-symptoms rated “at their worst in the past week” on a 0 to 10 Likert-type scale are included in this analysis. Time (linear, quadratic, and cubic), age (young vs. old), and time by age group interactions were evaluated using random coefficient modeling for each of the symptoms over 12 months. Results: In general, the severity of these selected symptoms declined significantly (p < .05) either linearly (memory problems and anxiety) or nonlinearly (fatigue, pain, constipation, peripheral neuropathy, nausea, lack of appetite, depression, and sleep disturbances) over time, except for vomiting which did not demonstrate a significant change over time. Age effects or age by time interactions (significant, p < .05, or a trend, .05 < = p < .10) were found for pain, constipation, peripheral neuropathy, vomiting, and sleep disturbances, with generally higher initial values for younger ( < = 70 years) women for pain and sleep disturbances and higher overall means for younger women for vomiting. For constipation and peripheral neuropathy, the nonlinear change over time varied significantly by age group, with the decline over time being more precipitous for older women. Conclusions: A better understanding of the different propensity for symptoms based on age can help clinicians not only address them but also choose chemotherapies to minimize them.
Using individual quality-of-life information as a clinical tool in patients with advanced cancer.
Authors: McInerney Veronica B , Waldron Dympna , Mannion Eileen 
Published: February 2017

91 Background: Use of quality of life information as a tool to aide decision making in routine clinical practice is uncommon. The Schedule of Evaluation for Individual Quality of Life Direct Weighting (SEIQoL DW) is a measurement tool that captures the multidimensionality and uniqueness of the individual allowing him/her to define areas of importance to their quality of life and to demonstrate its measure of importance. It was hypothesised that routine quality of life measurement of patients followed by graphical presentation of this information to the clinician, may bridge views of clinicians and patients to improve quality of life outcome. Methods: A randomised controlled trial of 65 patients receiving chemotherapy for advanced cancer was conducted to measure differences in perception of quality of life over 4 time-points of patients in the intervention group whose quality of life was reported to the clinical team compared to patients in the control group whose quality of life information was not reported to the clinical team .The primary objective was to compare quality of life outcome and examine differences between groups. Results: Findings demonstrated improvement in quality of life of all patients from baseline to time point 4. (P = > 0.05). The top four cues nominated by patients as important to their quality of life were health (92%), social activity (64%), keeping active (58%) and family support (43%).Closer analysis of these individual cues showed interesting differences between the intervention and control group. Participants in the intervention group demonstrated a 51% improvement in perception of health functioning compared to 19% improvement in perception of health functioning in the control group (p = 0.014).Paradoxically there was a decline in patient perception of functioning in other cues (social activity, keeping active and family support) with no significant difference between groups. Conclusions: Review of Individual QoL assessments by the clinican had a clinically significant impact on the patients reported measurement of ‘health’ thus suggesting that utilisation of QoL measurements by the clinician positively impacts the patient.
NEOHX study: Perioperative treatment with trastuzumab in combination with capecitabine and oxaliplatin (XELOX-T) in patients with HER-2 resectable stomach or esophagogastric junction (EGJ) adenocarcinoma—18 m DFS analysis.
Authors: Rivera Fernando , Jiménez-Fonseca Paula , Garcia Alfonso Pilar , Gallego Javier , Limon M. Luisa , Alsina Maria , Lopez-Gomez Luis , Galan MaCarmen , Falco Esther , Manzano Jose Luis , González Encarnación , Aranda Enrique , Fernandez Eva , Jorge Monica 
Published: February 2017

107 Background: Perioperative chemotherapy has demonstrated better OS and DFS than surgery alone in resectable stomach or EGJ adenocarcinoma. Trastuzumab has improved OS when added to chemotherapy in pts with HER-2 + metastatic gastric cancer and is interesting to explore its role in the perioperative setting. Methods: A Spanish, multicenter, open-label phase II study evaluated the efficacy and toxicity profile of perioperative XELOX-T (Capecitabine 1000 mg/m2/12h po days 1-14, oxaliplatin 130 mg/m2 day 1, trastuzumab 8 mg/kgà6 mg/kg day 1, q3w ; 3 preoperative cycles and 3 postsurgery cycles followed by 12 cycles of trastuzumab monotherapy) in patients with T1-2N+M0 or T3-4NxM0 resectable stomach or EGJ adenocarcinoma, HER-2+ ( IHQ3+ or IHQ2+/FISH+). The primary endpoint was 18 months DFS, secondary endpoint included pCR, R0 resection rate, ORR, toxicity of preoperative treatment (NCI CTC v3.0 criteria) and biomarker analysis. Results: From June 2010 to March 2012, 36 pts were included: median age 65 (39-85); ECOG 0/1/2: 16/19/1 pts; localization: stomach 21 pts, EGJ 15 pts; histologic type: intestinal: 23 pts, diffuse: 4 pts, mixed: 1pt, not specified 8 pts; TNM: T 4: 7 pts; N+: 31 pts. Preoperative XELOX-T: Response: PR: 14 pts (39%), SD: 18 pts, PD: 0 pts, NE: 4 pts. Surgery was performed in 31 pts: R0: 28 pts (78%, 95% CI: 61-90%), R1: 1 pt, R2: 2 pts (1 had peritoneal carcinomatosis); pCR was observed in 3 pts (8.3 %; 95% CI: 2-22%). Two pts died due to surgical complications. After R0/R1 resection, postoperative XELOX-T was administered to 24 patients, 22 of whom underwent T monotherapy. G3-4 toxicity (>5% of pts): diarrhea 33%, nauseas and vomiting 8% and pneumonia, anemia, neutropenia, anorexia, asthenia and pleural effusion with pneumothorax: 5.5%. With a median follow up of 24.1 months, 18m DFS is 71% (95% CI: 53-83%), 24 m DFS is 60% and median DFS and OS has not been reached. Conclusions: These data suggest that perioperative XELOX+T in HER-2 positive resectable stomach or esophagogastric junction adenocarcinoma is feasible and has promising activity. Clinical trial information: NCT01130337.
A randomized phase II factorial design trial of CPT-11 versus PTX versus each combination with S-1 in patients with advanced gastric cancer refractory to S-1: Final results of OGSG0701.
Authors: Nishikawa Kazuhiro , Imamura Hiroshi , Kawase Tomono , Gotoh Masahiro , Kimura Yutaka , Ueda Shugo , Matsuyama Jin , Kawada Junji , Sugimoto Naotoshi , Fujita Junya , Tamura Takao , Fukushima Norimasa , Sakai Daisuke , Shimokawa Toshio , Kurokawa Yukinori , Satoh Taroh , Tsujinaka Toshimasa , Furukawa Hiroshi 
Published: February 2017

117 Background: S1 + platinum (SP) is recognized as standard first-line chemotherapy for advanced gastric cancer(AGC), and S1 monotherapy is suggested for frail AGC patients or adjuvant setting in Japan. However, taxane or CPT-11 were often employed as second-line treatment for the patients who were resistant to S1-containing regimen. A retrospective analysis has reported that S1 combination chemotherapy extended overall survival as second-line treatment for AGC. Methods: Patients with AGC who confirmed disease progression by imaging after the first-line therapy with S1 or SP were randomized in four groups; CPT-11 150 mg/m2, day1, q2w (Group A), PTX 80 mg/m2, day1, 8,15, q4w (Group B), CPT-11 80 mg/m2, day1, 15, S-1 80 mg/m2, day1-21, q5w (Group C1), PTX 50 mg/m2,day1, 8, S1 80 mg/m2, day1-14, q3w (Group C2). Primary endpoint was overall survival (OS), and secondary endpoints were progression free survival (PFS), overall response rate (ORR) and safety. Sample size was set at 100 to 120 to achieve 2 months improvement of OS by using CPT-11 or by adding S1 with approximately 80% probability of the correct selection. Results: From July 2008 to March 2012, 127 patients were enrolled. The OS was 11.3/11.3/14.6/10.5 months(M) (Group A/B/C1/C2), 11.8M in Group A+C1 and 11.1M in Group B+C2 (p=0.922, HR: 0.981 [0.679-1.419]), 11.3M in Group A+B and 11.1M in Group C1+C2 (p=0.808, HR: 0.952 [0.643-1.412]), respectively. The PFS was 3.0/4.4/3.8/3.5M (Group A/B/C1/C2), 3.6M in Group A+C1 and 4.1M in Group B+C2 (p=0.035, HR:0.674 [0.468-0.972]) 3.7M in Group A+B and 3.7M in Group C1+C2 (p=0.931, HR: 1.017 [0.643-1.412]). The ORR was 7.1/16.3/4.5/5.0% (Group A/B/C1/C2), 4.7%[1.7-15.2] in Group A+C1 and 12.7%[5.6-23.5] in Group B+C2 (p=0.241), 11.8%[5.8-20.6] in Group A+B and 4.6%[0.6-16.2] in Group C1+C2 (p=0.572).Major Grade 3/4 toxicity (Group A/B/C1/C2, %), was leukopenia (12/7/5/0), neutropenia (29/16/24/24), nausea (7/2/10/5), diarrhea (5/0/10/0), and fatigue (5/2/10/5). Conclusions: From our results, we do not recommend consecutive use of S1 but CPT-11 or PTX monotherapy as second-line treatment in AGC refractory to S1 or SP. Clinical trial information: 000000677.