bluuebunny/crossref_metadata_2025_split huggingface dataset:
Development and validation of the clinician palliative perception scale (CPPS).
Authors: Wong Aaron Kee Yee 
Published: February 2017

179 Background: Worldwide healthcare systems identify a need to provide better evidence based service models for palliative care. There is little data and no standard tool that informs clinicians’ perceptions on palliative care to identify areas for service improvement and education. We aimed to develop and validate a tool to determine perceptions of hospital staff on palliative care provision, self confidence in providing palliative care, and predictors and barriers to requesting assistance. Methods: 604 hospital clinicians were recruited in person and online from a large metropolitan public tertiary teaching hospital network involving 5 campuses and 2 medical schools. They completed the CPPS (Clinician Palliative Perception Scale). Principal components analysis, exploratory factor analysis, and logistic regression were performed to examine the factor structure and relationship to clinical practice. Results: Four factors were extracted: confidence in providing palliative care, requesting assistance, global perceptions on palliative care provision, and barriers to referring. Increased confidence was significantly associated with increased likelihood of referring or requesting assistance and also associated with a good global perception on palliative care provision. Confidence was also significantly associated with years of experience and with spending > 50% time looking after dying patients. Good perception of palliative care provision was highest among oncologists. Conclusions: This is the largest quantitative study ever done looking at perceptions of palliative care provision among health professionals. The CPPS is a valid and reliable tool useful for both practice and research. Its 4 identified constructs are consistent with literature on perceptions and utilisation of palliative care services. Barriers to referring involved misconceptions that palliative care would prematurely shorten patient lifespans. Others did not refer due to confidence in their own skill. This tool can be used to correlate these constructs against other solid outcome measures to assist in service improvement and identifying research needs. It can also be used to determine clinicians’ educational requirements.
Patient-reported benefits of massage therapy as treatment for chemotherapy-related pain.
Authors: Menendez Alvaro G. , Carvajal Alejandro Ramon , Cobb Regina , Sahai Tanmay , D'Ambra Diane , Healey Kathi , Soriano-Pisaturo Maria 
Published: February 2017

192 Background: Massage Therapy (MT) has been suggested to provide symptom relief of chemotherapy related side effects. Its impact on pain improvement, prevention, and overall quality of life (QoL) is characterized in this study and 2 different pain scales are being compared. Methods: Patients who were on active chemotherapy and agreed to receive at least one MT session over a 10-week period were included. Wong-Baker Pain scale (WBPS) and Numerical Pain Scale (NPS) were assessed pre and post every session. Results: 62 pts were included. 25 pts were on analgesics (Opiates 64%, Gabapentin 24%, NSAIDs 12%). 34/62 pts had no complaints of pain on enrollment and only 9% (3/34) developed pain as per WBPS on subsequent visits. In 27/28 pts (97%) who had pain initially according to WBPS (0-4 scale), improvement was reported from X = 1.25 (5±5, M = 0, SD 2.31) to X = 0.32 after one MT session (4±4, M = 0, SD 1.16) (p < 0.05). 25/28 pts (89%) had maintained improvement from 1st to 2nd session with an average of 50%. 11% (3/28) reported worsening of pain symptoms with an X increase average of 2.66 (3±1, M = 2). NPS was positive for 37 patients on initial visit. NPS revealed a similar trend with pre-massage X of pain from 2.76 (5±5, M = 2, SD 2.87) to 1.18 (4±4, M = 0, SD 2.01) after 1st session (39.5% improvement) (p < 0.05). 18/25 (72%) saw a decrease in pain level per NPS (X = 2.27) between each session, whereas 28% noted worsening of pain by the end of their participation. Conclusions: MT is a high-value, low-risk intervention for reducing cancer pain and cancer treatment-related pain. MT could be used to address patients' need for emotional and physical human connection at a time when their quality of life is fragile. MT may offer pain prophylaxis when provided in a cumulative manner. NPS appears to be more sensitive than WBPS for pain screening in oncologic patients. Further studies are necessary to confirm the suggested findings of massage therapy for pain prevention and treatment.
The combination therapy with methylphenidate and American ginseng in cancer-related fatigue.
Authors: Chang Young , Smith Joshua , Portman Diane G. , Oberoi-Jassal Ritika , Rajasekhara Sahana , Davis Mellar P. 
Published: February 2017

215 Background: Fatigue is one of common symptoms among patients with cancer. However, little is known about the pathophysiology and effective pharmacologic intervention. Methylphenidate and American Ginseng were recognized for promising results and safe to use as a single therapy. Psycho-stimulants are commonly used and are effective in moderate to severe fatigue. The mechanism behind the evidence for methylphenidate is rebalancing dopamine neurotransmission which is altered in fatigue. The mechanism behind ginseng benefits appears to be improvement in muscle metabolism and reduction in inflammatory responses thought to cause fatigue in cancer. We hypothesized that combination therapy with methylphenidate and American ginseng is superior to single therapy and safe. Methods: We conducted retrospective chart review in the supportive care medicine outpatient clinic between Feb 01, 2015 and Dec 31, 2015. 28 patients were prescribed methylphenidate and American ginseng for 4 weeks. Methylphenidate dosage was between 10-20mg/day. American ginseng dosage was fixed at 2000mg/day (no control of sources). We investigated compliance rate, positive rate and change of fatigue score on ESAS. We also obtained the data for adverse effect ratio and severity as a safety measure. Results: We identified 28 patients (M: F 14/14, Age 50.4) who were prescribed combination therapy with methylphenidate and American ginseng for at least 4 weeks. 18 patients were compliant to combination therapy (Compliance rate 64%). 2 patients (11%) reported Grade 2 adverse effect while on therapy. One patient (5%) became non-compliant during the study period. 15 patients (84%) successfully completed the therapy the average fatigue score of pre and post intervention was 6.93 and 4.13 respectively (mean reduction -2.80, p-Value < 0.0002). 12 patients (80%) showed significant improvement of fatigue (reduced ≥ 2). There was no association between gender and age. Conclusions: Combination therapy with standard dose of methylphenidate and American ginseng were a safe and effective way of treatment for cancer-related fatigue. Further studies to confirm its safety and efficacy are justified.
Patterns of symptom control and palliative care-focused original research articles in major radiation oncology journals.
Authors: Di Giovanni Julia , Balboni Tracy A. , Chow Edward 
Published: February 2017

216 Background: National oncology and palliative care organizations recommend greater incorporation of palliative care in clinical care and research in advanced cancer to improve care quality. In radiation oncology, palliative oncology care represents approximately 30-40% of treatment courses. Given the frequency of palliative care in radiation oncology and recommendations for greater research at this intersection, we sought to determine the prevalence and patterns of publication of symptom control and palliative care focused original research articles in two prominent radiation oncology journals from 2004-2015. Methods: From 2005 to 2014, abstracts of original research manuscripts published in the International Journal of Radiation Oncology (Red Journal) and the Radiotherapy and Oncology (Green Journal) journals were reviewed to determine the number and content of abstracts relating to symptom control and palliative care (SCPC). Research articles were included if their abstract described a patient population with advanced or metastatic cancer and were considered focused on SCPC if symptom palliation was the goal of treatment or patterns of palliative care needs was the goal of the research inquiry. Change in annual proportion of SCPC abstracts over time was assessed with the χ-square trend test. Results: From 2005 -2014, 10.6% (593/5611: range 4.2-17%) of all original research articles published in the Red Journal and 14.5% (365/2516: range 12.2-17.4%) published in the Green Journal involved palliative care. In the Red Journal, 1.3% (75/5611) of original research articles were specifically focused on SCPC and 5.3% (133/2516) in the Green Journal. In both journals the number of abstracts did not change over time (p = 0.24). Randomized controlled trials accounted for a minority (10.6%, 22/208) of SCPC abstracts in both journals. Conclusions: SCPC-focused original research is poorly represented in two major radiation oncology academic journals. Palliative radiotherapy is a critical part of radiotherapy clinical practice and should be the subject of further research; particularly needed is research employing rigorous study designs.
Insurer pre-authorization and copayment for palliative patients with cancer receiving opioids other than morphine.
Authors: Vidal Marieberta , Reddy Akhila Sunkepally , Rodriguez Eden Mae , Bruera Eduardo 
Published: February 2017

217 Background: Uncontrolled pain is one of the main fears for patients with cancer and their families. Opioid analgesics are highly effective agents, but the choice of type, route, and dose needs to be personalized. The highly cost of some of them can make it difficult for patients to received adequate pain control without appropriate insurance coverage. There is a lack of information regarding the frequency of denials or heavy copayments by insurers. Methods: We evaluated 143 continuous opioid test claims for prescriptions by our palliative care providers for opioids other than morphine, including transdermal fentanyl, extended release oxycodone, hydromorphone and oxymorphone. We will categorize the test claims in 4 different groups: Approved with $0 to $49 dollars co-pay, Approved with high co-pay ($50 or more), Preauthorization required, and Direct Denial. Results: Among the 143 collected test claims 102 were for hydromorphone ER, 27 Oxycodone ER, Fentanyl TD 6 and Oxymorphone ER 8: 4 (3%) were rejected, 65 (46%) had a $0-50 copay , 28 (20%) had $50 or more copay and 46 (31%) needed prior authorization.). Conclusions: Only 65 ( 46%) of the prescriptions for opioids other than morphine had a copayment of 0-50$. Insurers’ copayment and requirements pose a major barrier for patients and physicians.
Improving provider adherence to evidence-based supportive care practices for patients with myeloma.
Authors: Stricker Carrie Tompkins , Faiman Beth , Harris Diana , Rozario Nicole 
Published: February 2017

218 Background: Rapidly emerging therapeutics for multiple myeloma (MM) have diverse and sometimes life-threatening toxicities, underscoring the need for proactive screening, assessment, and management to mitigate symptoms and adverse events [AEs] (i.e., “supportive care (SC) practices”). Little is known about the real-world systematic use of such strategies in routine MM clinical care. A 3 center pilot study aims to describe documented adherence to evidence-based SC practices, and then intervene with a novel ePRO and supportive care planning system (CPS) technology designed to improve adherence. Methods: 90 patients and 90 controls with MM from 3 sites are being evaluated in this pilot study. A scorecard to measure provider use of evidence-based SC practices, at the patient level, was developed by an interdisciplinary team, using an iterative process of literature review and a modified Delphi technique to gain metric consensus. The scorecard is applied to medical records of intervention subjects and controls over an 8-12 week period. Results: Scorecards have been completed to date for 20 historical controls & 7 intervention subjects; remaining to be complete by meeting. For controls, screening for specific symptoms was fairly consistent, but documentation of detailed assessments (e.g., severity, functional impact) and management strategies was poor. For intervention subjects to date, screening almost always was documented, and both detailed assessment and intervention was better than for controls in most cases. See table. Conclusions: For controls, providers regularly documented symptom/AE screening, yet detailed assessments and evidence of interventions were inconsistently documented. Barriers may include the limited availability of effective interventions for symptoms such as CIPN & fatigue, as well as time barriers to effective symptom assessment and management, and its documentation. Almost all metrics were better in intervention subjects to date. Although documentation may not reflect actual practice, improvement in detailed assessment and management strategies is likely needed, and a novel CPS technology may improve this state of affairs; evaluation ongoing. [Table: see text]
Rolapitant for control of chemotherapy-induced nausea and vomiting (CINV) in patients with gynecologic cancer.
Authors: Rapoport Bernardo Leon , Schwartzberg Lee Steven , Arora Sujata , Powers Daniel , Jordan Karin , Navari Rudolph M. 
Published: February 2017

223 Background: Rolapitant, a long-acting neurokinin-1 receptor antagonist, protected against CINV in patients receiving highly or moderately emetogenic chemotherapy (HEC or MEC). Methods: In 3 double-blind phase 3 studies, patients were randomized to receive oral rolapitant 180 mg or placebo before administration of HEC or MEC. All patients received a 5-hydroxytryptamine type 3 receptor antagonist and dexamethasone. In a post hoc analysis of 3 pooled studies (2 HEC and 1 MEC), we assessed the efficacy and safety of rolapitant in patients with gynecologic (ovarian, uterine, or cervical) cancer. Endpoints included complete response (CR; no emesis and no use of rescue medication), no emesis, no nausea (maximum visual analogue scale [VAS] < 5 mm), and complete protection (CP; no emesis, no use of rescue medication, and no significant nausea [maximum VAS < 25 mm]) in the overall (0–120 h), acute (≤ 24 h), and delayed (> 24–120 h) phases. Results: Of 201 patients with gynecologic cancer (60% ovarian, 28% uterine, and 12% cervical cancer), 55% received cisplatin-based HEC and 44% received MEC (99% of whom received carboplatin-based therapy). In the overall and delayed phases, improved rates of CR, no emesis, no nausea, and CP were observed with rolapitant compared with control (Table). The overall incidence of treatment-emergent adverse events was similar in the rolapitant and control groups (45% vs 54%). Conclusions: Rolapitant protected against overall and delayed CINV in patients with gynecologic cancer receiving HEC or MEC. Clinical trial information: NCT01500226, NCT01499849, NCT01500213. [Table: see text]
Evaluation of the palliative benefit and toxicity of Ra-223 treatment of men with hormone refractory prostate cancer in a community setting.
Authors: Vaghefi Houman , Xiong Bide , Liu Fang , Garber Elizabeth , Wheeler James 
Published: February 2017

225 Background: The ALSYMCA (Alpharadin in Symptomatic Prostate Cancer) trial was a phase III, placebo controlled, randomized trial in which 921 men with bone metastasis from hormone refractory prostate cancer (HRPC) were randomly assigned to receive radium-223 (Ra-223) or placebo. Ra-223 produced a 30% survival benefit, with a median survival of 14.9 months compared to 11.3 months for patients treated with a placebo, which led to FDA approval in 2013. Methods: We identified through the nuclear medicine records 11 patients who started Ra-223 between March 15, 2013 and December 10, 2015. The Wilcoxon signed rank test was used to compare the published results of the ALSYMPCA patients with those from our institution. Results: The Hodges-Lehman estimate of the median survival of our patients from the date of the first Ra-223 infusion was 7.8 months. The 95% confidence interval (CI) was (2.8, 14.7; p = 0.0122) indicating our patients had a significantly shorter survival. Our patients did not have a statistically significant worse rate of anemia, neutropenia, or thrombocytopenia. Only 27.3% (95% CI: 6.0, 61.0%) of our patients completed all 6 planned infusions significantly less than 63% for the ALSYMPCA patients treated with Ra-223 (p = 0.0239), but not statistically different than the placebo patients (p = 0.236). The median survival from the last Ra-223 was 3.53 months. We used 3 measures of treatment effectiveness: (1) reduction in the pain scores, (2) reduction in the serum PSA, and (3) reduction in the alkaline phosphatase. Compared to the pre-treatment values, numerical reductions were seen at the last follow-up evaluation for both the pain scores and the alkaline phosphatase levels, but the reductions were not statistically significant. Conclusions: Not all patients with castration resistant prostate cancer benefit from Ra-223 to the same extent as the ALSYMPCA patients. It is important to identify patients with a sufficient life expectancy to benefit from this treatment.
Efficacy of triple antiemetic therapy (palonosetron, dexamethasone, aprepitant) for chemotherapy-induced nausea and vomiting in patients receiving carboplatin-based, moderately emetogenic chemotherapy.
Authors: Miya Toshimichi , Kobayashi Kunihiko , Hino Mitsunori , Ando Masahiro , Takeuchi Susumu , Seike Masahiro , Kubota Kaoru , Gemma Akihiko 
Published: February 2017

226 Background: Chemotherapy-induced nausea and vomiting (CINV) is a major adverse toxicity of cancer chemotherapy. Recommended treatments for prevention of CINV vary among guidelines, and optimal care for CINV caused by moderately emetogenic chemotherapy has not been established. This study assess efficacy and safety of triple antiemetic therapy consist palonosetron, dexamethasone and aprepitant for carboplatin-based chemotherapy. Methods: Chemotherapy-naïve patients with lung cancer scheduled for a first course of a carboplatin-containing regimen formed the study cohort. Patients were pretreated with antiemetic therapy consist palonosetron (0.75 mg, i.v.) and dexamethasone (9.9 mg, i.v.) on day 1, and aprepitant (125 mg, p.o.) on day 1 followed by 80 mg on days 2 and 3. Primary endpoint was the proportion of patients who did not experience vomiting and did not require rescue medication (complete response (CR)) in the acute phase (0-24 h), late phase (24-168 h) and overall. Secondary endpoint was the proportion of patients who experienced no vomiting episodes and no more than mild nausea without the need for rescue medication (complete control (CC)). Results: Prevalence of a CR during the acute phase, delayed phase, and overall was 100%, 91.9% and 91.9%, whereas that of CC was 100%, 84.4% and 84.4%, respectively. Most common adverse events were mild constipation; severe adverse events related to antiemetic treatment were not observed. Prevalence of a CR during the acute phase, delayed phase, and overall was 100%, 91.9% and 91.9%, whereas that of CC was 100%, 84.4% and 84.4%, respectively. Most common adverse events were mild constipation; severe adverse events related to antiemetic treatment were not observed. Conclusions: Triple antiemetic therapy comprising palonosetron, dexamethasone and aprepitant shows excellent effects in preventing CINV in patients receiving a carboplatin-containing regimen. Clinical trial information: UMIN000017877.
Toxicities of the anti-PD-1 immune checkpoint antibody nivolumab in the acute inpatient setting.
Authors: Brito-Dellan Norman 
Published: February 2017

227 Background: Knowledge of immune-system regulation led to the discovery of immune checkpoints molecules, which have demonstrated anti-tumor activity across various malignancies. These advances represent a new set of challenges for clinicians, including non-oncologists treating the cancer patient, who must develop a working knowledge of the mode of action of these agents, their unique response kinetics, and how to diagnose and effectively manage their toxicities. Nivolumab is a monoclonal immune checkpoint antibody that binds to the PD-1 receptor on T-cells, blocking PD-1 pathway-mediated anti-tumor immune response inhibition. Methods: Review of current literature and analysis of 3 cases of patients with Nivolumab-related toxicities at a major cancer center. Results: Case #1: 74 years-old female with NSCLC who was started on nivolumab after developing disease progression with various regimens. Nivolumab was held 4 months later due to development of erythematous, edematous papules and plaques, with overlying ulcerations and crust in forearms, thighs and trunk. Also, paronychias and loss of nail beds in both great toes. She developed no new lesions after discontinuation of immunotherapy. Case #2: 71 years-old male with right lung NSCLC, started on Nivolumab after evidence of disease progression after completion of carboplatin/paclitaxel. Four months later developed grade 2 Nivolumab-induced pneumonitis; this was withheld and ultimately discontinued due to persistent pneumotoxicity in spite of corticosteroids. Case #3: 41 years-old male with synchronous right lung ALK-positive adenocarcinoma, on crizotinib, and left lung squamous cell carcinoma, on nivolumab. He developed nivolumab-induced ANCA-negative glomerulonephritis, which was discontinued while continuing the crizotinib. His renal function normalized 3 months later, with GFR going from 14 to 122. Conclusions: Most adverse events with the anti-PD-1 agent Nivolumab are generally reversible after discontinuation of therapy, yet some high-grade immune-related adverse events require management with corticosteroids and other immune modulating agents. Further research is needed.