bluuebunny/crossref_metadata_2025_split huggingface dataset:
Using a symptom observation chart for dying patients: Review of a service improvement tool.
Authors: Waterman Lauren Z , Varma Neha , Doherty Ambre , Cooper Max , Mason Louise D 
Published: February 2017

57 Background: In July 2014, following judicial review, the Liverpool Care Pathway for Dying Patients was withdrawn from the UK. An individualised approach to care for dying patients was advised, laid out in “One chance to get it right”. To support this, a symptom observation chart was developed at BSUH, a UK teaching hospital with cancer centre. At the point where a patient is diagnosed as dying, this innovative tool replaces vital signs assessment tools and facilitates regular and rigorous assessment of symptoms. Additionally, it aims to improve communication between healthcare professionals (HCPs), by showing trends in symptoms over time, and to trigger urgent physician review if optimal comfort is not achieved. It has scoring and escalation prompts, similar to early warning score charts, using a red-amber-green system. Methods: 8 months after introduction, a self-completed questionnaire was distributed to HCPs. Questions related to demographic data, opinion on the chart using a 4-point Likert scale and a qualitative component. Results: 135 adequately completed questionnaires (of 150) were returned by ward nurses (61%), physicians (30%), nursing assistants (7%) and palliative care specialist nurses (3%). The majority "agreed" or “strongly agreed” that the chart was user-friendly (97%); not time consuming (98%); facilitated communication between staff of the multidisciplinary team (87%); prompted earlier intervention from physicians (83%); was useful to indicate poorly controlled symptoms (96%); had improved the symptom assessment of dying patients (91%); and had contributed to improvements in the overall care of dying patients (87%). Additionally, 86% of nurses felt the chart helped them know when to request an urgent physician review to optimise comfort. Only 51% felt they had received enough training in using the chart. These findings were also reflected in free text responses. Conclusions: The vast majority of HCPs found the chart easy to use and felt it improved overall care of dying patients. Therefore, the chart may be a valuable addition to Comfort Care Order Sets. Prospective research is warranted to further assess the chart. The chart will be visually presented. It may be adapted and reproduced with permission.
The role of pannexin 1 in chemotherapy-induced peripheral neuropathy (CIPN).
Authors: Sterman Adam , Hanstein Regina , Spray David C. 
Published: February 2017

6 Background: CIPN is a debilitating side effect and dose limiting toxicity of anticancer drug therapies. CIPN induces pathological changes in dorsal root ganglia (DRG), leading to increased cross-talk between sensory neurons and satellite glial cells (SGCs), specifically ATP mediated SGC-neuron signaling. We therefore investigated CIPN in mice with neuron- or glia-specific deletion of the ATP-releasing channel Pannexin 1 (Panx 1). Methods: To induce CIPN, mice were given two i.p. oxaliplatin (oxa) injections two days apart. Controls received saline (sal). We used C57Bl6 wildtype and transgenic mice with neuron- or glia-specific Panx1 deletion (NFHcre or GFAPcre:Panx1F/F) and littermate controls (Panx1F/F), 7-11 per group. Tactile sensitivity of the hindpaws was assessed prior to and every week after injections for 3 weeks using von Frey filaments. The number of paw withdrawals to 10 stimulations with each filament and pain thresholds (corresponding to filament that elicits 8/10 responses) were recorded. Overall mouse condition was assessed using Open Field Tests. Results: C57Bl6 mice developed transient tactile hypersensitivity after oxa injection, which was most prominent at day 9 and ceased at day 21. Oxa-injected mice had lower tactile thresholds (at 9 days: sal 5.5±0.3g vs. oxa 2.7±0.4g, p < 0.001) and higher response rates to filaments compared to sal-injected controls (p < 0.05), but revealed no changes in any other behavior. Mice with glia-specific Panx1 deletion did not display significant tactile hypersensitivity at any time after oxa (tactile threshold at 9 days: sal 5.5±0.3g vs. oxa 5.8±0.2g), whereas oxa induced tactile hypersensitivity did occur in mice with neuron-specific Panx1 deletion (at 9 days: sal 6±0g vs. oxa 1.3±0g, p < 0.0001) and Panx1F/F littermates (at 9 days: sal 6.0±0g vs. oxa 1.3±0.1g, p < 0.0001). Conclusions: We found that oxaliplatin induces transient CIPN, but no other behavioral changes in wildtype mice. Deletion of the ATP-releasing channel Panx1 in glia, but not in neurons, prevented CIPN development. This points to a new molecule (Panx1) and a new cell type (glia) as potential novel targets for pain therapy.
Agreement between physician and patient performance status ratings in an outpatient setting.
Authors: Popovic Gordana , Pope Ashley , Harhara Thana , Swami Nadia , Le Lisa , Zimmermann Camilla 
Published: February 2017

66 Background: Performance status (PS) scores are generally completed by physicians, although patient PS measures are increasingly available. The objective of this study was to assess agreement between physician-recorded Eastern Cooperative Oncology Group (ECOG) PS and a patient-rated measure of performance status based on the ECOG measure in an outpatient oncology palliative care clinic. Methods: Physicians recorded ECOG PS for every patient as part of routine clinical practice. Patients recorded their PS using a measure based on the ECOG, where 0 = normal with no limitations; 1 = not my normal self, but able to be up and about with fairly normal activities; 2 = not feeling up to most things, but in bed or chair less than half the day; 3 = able to do little activity and spend most of the day in bed or chair; and 4 = pretty much bedridden, rarely out of bed. Patients also completed the ESAS-CS measure. Medical and demographic data were abstracted from the patients’ charts. We examined correlation between physician and patient PS measures as well as factors associated with a difference in patient versus physician measures for 949 patients with a visit between August 1, 2013 and December 31, 2014. Results: Weighted Kappa statistics indicated moderate inter-rater agreement at 0.32 (95%CI: 0.28-0.36). On average, patients rated their ECOG higher by 0.31 (95%CI: 0.25-0.37, p < 0.0001); 40.7% of patients rated their PS worse, 41.9% the same, and 17.3% better than did physicians. Worst agreement was for ECOG 0 (5 of 25 patients rated 0 by physicians also rated 0 themselves, 20% agreement); the highest agreement was in those with physician-rated ECOG 3 (87/136 patients, 64% agreement). Older patients reported better PS than physicians (p = 0.002) while those with worse ESAS distress scores reported worse ECOG than physicians (p < .0001). Conclusions: Patients tend to rate their PS as worse than rated by physicians, particularly those with greater symptom burden. However, older patients tend to rate their PS as better. This could be due to age bias of physicians or due to older patients assessing their PS optimistically. Future research will assess the survival data of participants to assess correlation of PS assessments of each group with prognosis.
Development of a patient-reported outcome (PRO) instrument to facilitate timing of end-of-life (EOL) discussions in patients with advanced cancers.
Authors: Contreras Jose , Pecora Andrew , Schultz Eric V , Choi Kelly , Smith Augie , Paramanathan Dhakshila , Demarco Katie , Goldberg Stuart L. 
Published: February 2017

74 Background: Honoring the wishes of terminally ill cancer pts is a prime responsibility of oncologists, however EOL discussions are frequently either never performed or delayed past the point of usefulness. Pts who discuss EOL issues with their medical team are more likely to avoid terminal hospitalizations, have improved emotional wellbeing and experience lower health care costs. Facilitators of timely EOL discussions including palliative care consultations would be beneficial. Methods: A 7-item PRO instrument “Living with Cancer” has been developed by COTA (Cancer Outcomes Tracking & Analysis) covering 4 domains: performance status, pain, burden (financial and time), and depression. Each item queried a domain (the pain I experience is: Non-existent, Mild, Moderate, Severe, Unbearable) yielding scores 0 to 4. A unique feature is that each item is multiplied by the pt’s assessment of the importance of the question (multiplier 1-4), yielding a maximum score 112. The pt’s physician (without knowledge of PRO responses) assigned opinions as to status (should continue treatment, beginning to discuss EOL, actively in EOL discussions). Results: 433 pts with advanced malignancies undergoing non-curative therapy completed the PRO instrument between February-March 2014 at the John Theurer Cancer Center. The median scores for pts deemed by their physician appropriate to continue non-curative treatments, contemplating EOL discussions and actively in EOL discussions were 14, 23, and 35 respectively. Results varied by tumor type, with larger differences among cohorts of lung, breast, GI malignancies, and considerable overlap among multiple myeloma pts. A score of > 28 indicated < 25% chance of being in the physician deemed continue therapy group and 40-60% chance of being in the physician determined EOL discussion categories. Conclusions: A 7-item PRO (that includes pt views of importance of each domain) was able to separate advanced malignancy pts into cohorts who their physicians deemed were at differing stages of EOL discussion appropriateness. A prospective study in lung cancer evaluating consultation rates by total score (encouraging discussions if > 28) is ongoing.
Quality of life and mood in patients with advanced cancer: Associations with prognostic understanding and coping style.
Authors: Nipp Ryan David , El-Jawahri Areej , Pirl William F. , Fishbein Joel , Moran Samantha M.C. , McCarty Caitlin , Eusebio Justin , Gallagher Emily R. , Park Elyse R. , Jackson Vicki A. , Greer Joseph A. , Temel Jennifer S. 
Published: February 2017

76 Background: Patients’ prognostic understanding and coping styles influence their treatment decisions, but how these factors relate to their quality of life (QOL) and mood has not been well described. We sought to examine the associations of patients’ prognostic understanding and coping style with their QOL and mood. Methods: As part of an ongoing trial of early palliative care, we are assessing baseline QOL (Functional Assessment of Cancer Therapy-General), mood (Hospital Anxiety and Depression Scale), coping (Brief Cope) and prognostic understanding in patients within 8 weeks of diagnosis of advanced lung or gastrointestinal (GI) cancer. To determine associations, we used linear and logistic regression, controlling for patients’ age, sex, cancer type and marital status. Results: Of 300 participants (mean age = 64.7 years; 138 (46%) female), 132 (44%) had GI cancer and 168 (56%) had lung cancer. Using cutoff score > 7 for the HADS, 61 (20%) and 85 (28%) reported depression and anxiety. 138 (49%) reported their prognosis as terminal. A terminal perception of prognosis was associated with lower QOL and higher rates of anxiety. Emotional support, acceptance, and active coping styles were associated with better QOL and mood. Denial and self blame were associated with worse QOL and mood. Conclusions: These data demonstrate that acknowledging a terminal prognosis may be associated with greater physical and psychological distress, or conversely, patients with worse QOL and mood may better appreciate the gravity of their illness. Certain coping styles (self blame and denial) are associated with lower QOL and higher distress. Understanding the relationships among patients’ prognostic awareness, coping styles, QOL and mood will allow us to develop more effective supportive care interventions. Clinical trial information: NCT01401907. [Table: see text]
The utility of the surprise question in identifying patients most at risk of death.
Authors: Vick Judith B , Pertsch Nate , Hutchings Mathilde , Neville Bridget A. , Lipsitz Stu , Gawande Atul , Block Susan , Bernacki Rachelle 
Published: February 2017

8 Background: Understanding the cancer patient’s prognosis in all illness phases is important. Evidence suggests that the “Surprise Question” (SQ) -- “Would you be surprised if this patient died within the next year?” -- may be useful in identifying those most at risk of death, but prior studies are limited by the relatively small number of patients and clinicians included. Methods: From July 2012 to October 2014, oncology clinicians at Dana-Farber Cancer Institute were invited to enroll in a randomized controlled trial on the impact of a structured intervention to improve conversations about end-of-life goals -- the Serious Illness Care Program. The SQ was asked about each patient seen by the enrolled clinician. We used a weighted propensity score approach to calculate adjusted proportions of survival at 6 months and 1 year, clustering by SQ clinician. To determine which variable was most predictive of death, we fit a multivariable Cox model, and found the variable that led to the largest increase in the Cox-regression goodness-of-fit c-statistic. Results: 81 oncology clinicians (59 oncologists, 18 nurse practitioners, and 4 physician assistants) enrolled in the study and we had complete data on 4617 patients: 3821 (83%) for whom the clinician answered “Yes” to the SQ and 796 (17%) for whom the answer was “No.” Propensity-adjusted 1-year survival for “Yes” patients was 93% (95%CI 91-96%) compared to 53% (95%CI 46-60%) for the “No” patients (p < 0.0001). The SQ was more predictive of patient death than type of cancer, age, cancer stage, or time since diagnosis. Sensitivity of the “No” response was 59% (95%CI 49-68%) and specificity was 90% (95%CI 86-93%). Positive predictive value was 49% (95%CI 45-54%) and negative predictive value was 93% (95%CI 90-95%). Conclusions: The Surprise Question identifies cancer-center patients at high risk of death within one year better than clinical variables such as cancer type, stage, patient age, or time since diagnosis.
Symptom burden, health-related quality of life, and treatment preference over time as reported by patients with metastatic colorectal cancer (mCRC).
Authors: Jones Amy Little , Bhavsar Nrupen Anjan , Abernethy Amy Pickar , Zafar Yousuf 
Published: February 2017

82 Background: Clinicians have difficulty predicting longitudinal changes in patient symptom burden and quality of life, and then how those changes might affect treatment preference. The primary aim of this pilot study was to investigate how self-reported symptom burden, quality of life, and treatment preference change over time in mCRC patients with limited life expectancy. Methods: Eligible mCRC patients had incurable disease, received chemotherapy at Duke or Duke Raleigh, were > = 18 years old, and spoke English. Patients were surveyed at each clinic visit and followed for up to 3.8 years on study. Measures included FACT-C (Functional Assessment of Cancer Therapy-Colorectal), PCM (Patient Care Monitor; a validated, 87-item review of systems survey; items measured on a 0-10 scale), and QQQ (Quality-Quantity Questionnaire; a validated, 8-item measure of cancer patient preference for quantity vs. quality of life; items measured on a 1-5 Likert scale). Demographic, disease, and treatment data were abstracted from the medical record. Results: The 56 patients were primarily male (68%) and Caucasian (79%) with a mean age of 55 at diagnosis of metastatic disease. Patients answered surveys a mean of 6.8 times each, with a median 364 days between first and last surveys. Over time, patients reported most symptoms improved or stayed the same (72%, n = 63 symptoms). Mean symptom scores that improved the most from first to last survey were fatigue (3.92 to 3.03) and nausea (2.1 to 1.4), while pain (1.9 to 2.5) and cough (0.4 to 0.7) worsened the most. Decision making about treatment preference also did not change over time, with mean QQQ scores from first survey (22, n = 28) to last survey (22, n = 16) remaining stable. Mean QQQ length and quality scores likewise were unchanged (12.9 to 12.8; 12.4 to 12.2 respectively). Conclusions: In this pilot study of mCRC patients with limited life expectancy, reported symptom burden scores remained stable or modestly improved over time, while preferences for quality vs. quantity of life remained stable. These findings suggest that patients with advanced cancer might perceive symptom burden differently over the course of their treatment.
Severity of and contributors to distress in patients with acute myeloid leukemia (AML) receiving induction chemotherapy.
Authors: LeBlanc Thomas William , Wolf Steven Paul , Davis Debra M. , Samsa Greg , Locke Susan C. , El-Jawahri Areej , Tulsky James A. , Abernethy Amy P 
Published: February 2017

83 Background: Distress screening is a recommended component of comprehensive cancer care, and is now required as a condition of cancer center accreditation by the American College of Surgeons Commission on Cancer. However, the etiology and severity of distress in patients with AML has not been described. Methods: We enrolled hospitalized patients with AML initiating induction chemotherapy, and assessed their distress levels weekly during their month-long hospitalization using the NCCN distress thermometer (DT). The DT is a validated (0-10), 11-point ordinal scale with an accompanying 39-item problem list. We analyzed data using descriptive statistics and Kruskal-Wallis tests. Results: Twenty-six patients provided complete data for analysis.Mean age of study participants was 58.7 (SD 12.2). Patients had high-risk disease characteristics including 13 (50%) being > 60 years old, 13 (50%) with high-risk cytogenetics, and 9 (31%) with relapsed disease. Distress levels were high during the first week of induction (median 5.5; IQR 2-8). The most frequent concerns were largely from the “emotional problems” section of the DT problem list, including: worry (77%), nervousness (62%), fears (54%), and sadness (54%). Physical problems like fatigue (69%) and sleep difficulties (58%) were also prominent. Median distress scores remained above the NCCN DT threshold for referral to support services (score ≥ 4) in weeks 2 and 3 (median scores: 4 (1-8) and 5.5 (2-7), respectively), but improved to 2 (1-6) in week 4. Nervousness and worry were significantly improved at week 4 (p < 0.01), but sadness persisted in 32% and fatigue in 60% of patients at the 4th assessment. Problems with eating and with diarrhea were also still prominent in week 4, at 48% and 36% respectively. Conclusions: Distress is prominent among inpatients with AML receiving induction chemotherapy, with frequent psychological concerns upfront, and persistent symptom distress in later weeks of therapy. These findings underscore the burden of unmet palliative care needs among hospitalized patients with AML. Interventions are needed to address psychological and physical distress in this population.
Evaluating the utility of the QUAL-EC in the clinical care of patients with advanced cancer.
Authors: Wilkinson Anne , Slatyer Susan , Nowak Anna , Pienaar Cathy , Tandon Anil , Wallace Mark 
Published: February 2017

86 Background: We piloted the Quality of Life at the End of Life (QUAL-E) in Australian palliative care in-patients (N=52) and demonstrated feasibility, acceptability and face validity. An unexpected finding was the potential for the QUAL-E to prompt psycho-social-spiritual discussion when conducted as an interview, indicating opportunities for enhanced support. For this study, we compared a 17-item QUAL-E-Cancer (QUAL-EC) to the Distress Thermometer Screening Tool (DT) and participants’ experience when the QUAL-EC was conducted as an interview. Methods: A cross-sectional, mixed methods design was used. Convenience sampling recruited patients (N=50) with advanced cancer and a prognosis of less than 12 months from a tertiary hospital. Participants completed the DT, followed by the QUAL-EC which was digitally recorded as an interview. Results: Correlational and thematic analysis found that 39.6% of participants reported severe distress (score ≥7) while 40% reported moderate distress (score 4-6) on the DT. Levels of distress significantly correlated with two QUAL-EC domains: symptom control (r=0.52, p<0.001) and preparation for end of life (r=0.32, p<0.05). Qualitative analysis identified six themes: the health care team; family issues; approaching death; worry; coping and QUAL-EC experience. Feasibility: completion of the QUAL-EC ranged from 3-14 minutes (M=7.37 minutes, SD 3.05 minutes). Acceptability: Participants overwhelmingly found the questions to be clear and did not find the questions hard to understand, hard to answer or stressful. Ninety percent of participants agreed or strongly agreed that they were glad they took part. Conclusion. Patient distress was associated with either symptom burden or concerns about their family/loved ones. Conclusions: When distress is identified on screening, the QUAL-EC offers good potential for nuanced, versus vague assessment of globalised distress (e.g., DT) as an aid in targeting patient-centered clinical/psycho-social interventions.
A systematic review of end of life cancer care in the elderly population in Qatar: A retrospective cohort study.
Authors: Hassan Azza Adel , Allam Ayman , Jacob Cicy Mary 
Published: February 2017

87 Background: Managing cancer in the elderly ( ≥ 65 years of age) is quite challenging as a result of associated comorbidities, poor performance status and the expected lower tolerance to treatment. The aim of the present study is to report on the demographics of cancer in the elderly population at NCCCR, also to analyze different indicators constituting End of Life (EoL) care in this subgroup of patients. Methods: Elderly patients ( ≥ 65 years of age) presenting with cancer diagnosis to NCCCR between January 01, 2009 till December 31, 2013 constituted the cohort study group. Their medical records were reviewed for the following items: Diagnosis, Performance status, age, comorbidities, treatment received, place of death, Length of Stay (LOS) during last hospitalizations as well as aggressiveness of care at EoL. Patients were then subdivided into 3 age groups: 65-74 years (n = 175), 75-79 years (n = 63) and ≥ 80 years (n = 54). Results: The most common diagnosis was colorectal cancer (42%, 35% and 46% in the 3 age groups respectively). The palliative ward was the most common place of death (43%, 46% and 36% respectively) followed by Medical ICU (26%, 14% and 20% respectively). The median survival from the date of admission in last hospitalization was not different in the 3 age groups (9.4 days vs 9.11 days vs 8.8 days respectively). There was no statisticallly significant differences between the 3 age groups as regards any of the 6 indicators of aggressive care. However, a high percentage of ICU admissions (ranging between 20% - 29%) was reported across all age groups. Conclusions: Colorectal cancer is the most common type of cancer in elderly population in Qatar. Admission to ICU in the last month of life was high, ranging between 20-29%. The mean LOS of last hospitalization was short ranging between 8.8 - 9.4 days. These findings would warrant the development of a needed community palliative care service that would allow this group of patients to receive their EOL care at home, rather than in hospital.