bluuebunny/crossref_metadata_2025_split huggingface dataset:
Advance directives: Cancer patients’ preferences and family-based decision making.
Authors: Li Xing , Lin Zhi-Huan , Hong Ying-Fen , Ma Xiao-kun , Wu Dong-hao , Xing Yan-Fang , Wu Xiang-yuan , Lin Qu 
Published: February 2017

18 Background: Advance directives (ADs) are a sensitive issue among traditional Chinese people, who usually refrain from mentioning this topic until it is imperative. Medical decisions for cancer patients are made by their families, which might violate patients’ personal will. This study was aimed to examine the acceptance of ADs among Chinese cancer patients and their families and patient participation in this procedure. Finally, to analyze the moral risk involved. Methods: Participants included 412 adult cancer patients from 9 leading hospitals across China. An AD was introduced to the main decision makers for each patient; if they wished to sign it, the AD would be systematically discussed. A questionnaire was given to the oncologists in charge of each patient to evaluate the interaction between families and patients, patients’ awareness of their disease, and participation in an AD. Results: A total of 246 patients and their family members rejected systematic discussion of AD, the majority (95.5%) of whom were under anti-cancer treatment. An additional 166 patients or their families accepted the concept of an AD and signed an AD to give up invasive treatment. This decision was make shortly after termination of anti-cancer therapy. Correlational analysis revealed that patients living in villages and who were subordinate members in their families tended to accept an AD. Of these, only 24 patients participated in the decision making. Correlational analysis revealed that patients with a better financial situation, living in cities, and superordinate status in their families tended to participate in the AD discussion, as well as those who usually made medical decisions themselves. Nearly all the patients deciding their own AD knew their entire situation, including diagnosis and prognosis. For 101 patients, anti-cancer therapy was ended prematurely, with as many as 37 patients not told about their potential loss of health interests. Conclusions: ADs were widely accepted among Chinese cancer patients when anti-cancer therapy was terminated. Most cancer patients were excluded from the discussion of an AD. Thus, AD could be formally introduced to the family of Chinese cancer patients after termination of anti-cancer therapy.
Survival among cancer patients undergoing opioid rotation to methadone as compared to other opioids.
Authors: Reddy Akhila Sunkepally , Yennu Sriram , Schuler Ulrich S. , De la Cruz Maxine Grace , Wu Jimin , Liu Diane D , Bruera Eduardo 
Published: February 2017

183 Background: Recent studies have reported that methadone has antineoplastic activity. Other studies have associated methadone with lower overall survival in patients with chronic pain. Methadone is the most frequent opioid chosen for purpose of opioid rotation (OR) in cancer patients experiencing refractory pain or opioid induced neurotoxicity. There is no data available on the association of methadone with overall survival in cancer patients. Our aim was to compare the characteristics and overall survival in cancer patients in methadone group with other strong opioid group. Methods: In this ad hoc analysis, we reviewed 2471 consecutive patient visits to the supportive care center of a tertiary cancer center in 2008 for ORs from strong opioids to methadone or other strong opioids with a follow-up visit within 6 weeks. Information regarding demographics, Edmonton Symptom Assessment Scale (ESAS), and morphine equivalent daily dose (MEDD) were collected. Successful pain response was defined as 2-point or 30% reduction in pain score. Kaplan-Meier curves were used to evaluate survival. Results: Of the 102 eligible patients, 54 underwent OR to methadone and 48 to other strong opioids. The median age was 56 years, 56% were male, and 81% had advanced cancer. There were no significant differences between the methadone group and the other opioid group in patient characteristics, performance status, MEDD, and ESAS scores. Although both the groups showed significant pain response, methadone group (72%) had a significantly higher pain response as compared to the other opioid group (65%; P = 0.04). The Kaplan-Meier curves revealed no significant difference in overall survival (OS) between the methadone group and the other opioid group [median OS: 5.2 months (95% CI 3.64-7.41) vs. 5.9 months (95% CI 2.6-9.2); P = 0.89]. Conclusions: We observed no significant difference in overall survival in cancer patients in methadone group as compared to other opioids. Further validation studies in a larger sample are warranted.
Thromboembolic events in hospitalized cancer patients: Impact on stay duration and cost for four major cancer localizations.
Authors: Scotte Florian , Vainchtock Alexandre , Martelli Nicolas , Borget Isabelle 
Published: February 2017

186 Background: Cancer patients represent an at-risk population for Venous Thromboembolic Events (VTE). Our study aimed to evaluate the impact of VTE on the length and cost of hospital stay in French patients hospitalized for breast cancer (BC), colon cancer (CC), lung cancer (LC) or prostate cancer (PC). Methods: The French national hospital database (PMSI) and the disease-specific ICD-10 codes were used to identify BC, CC, LC or PC patients diagnosed in 2010 who were hospitalized with a VTE during the following two years. We selected stays during which a VTE occurred but was not the main reason of hospitalization (cancer was classified as primary/related diagnosis and VTE as significant associated diagnosis). Those stays were matched and compared to similar stays (same cancer and same reason for hospitalization) without VTE. Costs were calculated using the French official tariffs, from the perspective of the third-party payer. Results: We identified 214 stays for breast cancer during which a VTE occurred and was classified as significant associated diagnosis, 843 stays for colon cancer, 1301 for lung cancer, and 126 for prostate cancer. The comparison between those stays and similar stays without VTE showed significant increase of hospital stay duration in patients experiencing VTE. Median duration rose from 4 to 7 days in BC patients, from 8 to 16 days in CC, from 2 to 9 days in LC and from 6 to 10 days in PC. Consequently, the median expenditure per stay increased by 37% in BC patients with VTE (up to € 5,518), by 61% in CC (up to € 9,878), by 202% in LC (up to € 7,308) and by 22% in PC (up to € 6,200). Conclusions: When occurring during hospitalization, VTE made cancer management much heavier: patients faced prolonged hospital stays whereas healthcare system faced significant additional cost. Better prevention and follow-up measures could reduce this burden, and benefit both patients and hospitals. [Table: see text]
The effects of dexamethasone and placebo on symptom clusters in advanced cancer patients: A preliminary report.
Authors: Yennu Sriram , Williams Janet L. , Chisholm Gary B. , Bruera Eduardo 
Published: February 2017

187 Background: Advanced cancer patients frequently experience debilitating symptoms that occur in clusters, but few pharmacological studies have targeted symptom clusters. Our objective was to examine the effects of dexamethasone on symptom clusters. Methods: Secondary analysis of a recent RCT of dexamethasone (DEX) vs placebo (PL) on cancer symptoms as assessed by FACIT-F-Fatigue; FAACT-Anorexia-Cachexia; BPI - Pain; HADS- Anxiety-Depression; ESAS: Sleep, Drowsiness, Dyspnea. Symptom clusters were identified based on baseline symptoms [ESAS] using principal component analysis. Cluster scores were computed by adding each scale divided by the maximum value for the scale: Fatigue- Anorexia-Depression = (Fatigue /52 + Anorexia/48+ HADS-Depression/21); Sleep-Anxiety-Drowsiness = (Sleep/10+HADS-Anxiety/21+Drowsiness /10); Pain-Dyspnea = (BPI/10 +Dyspnea /10). Higher number indicates better QOL. Correlations and change in the severity of symptom clusters were analyzed. Results: In 114 evaluable patients, 3 clusters accounted for 63% of the total variance at baseline: Fatigue-anorexia/cachexia-depression cluster (FAD); sleep-anxiety-drowsiness cluster (SAD) and Pain-Dyspnea cluster (PD). Median (IQR) improvement in the FAD cluster at Day 15 and Day 8 was significantly higher in the DEX than in the PL group [0.22 (-0.04, 0.45) vs. 0.06 (-.30, .20), P = 0.016)] and [0.15 (-0.84, 0.35) vs-0.095 (-0.35, 0.16), p = 0.017] respectively. There was no significant change observed in SAD and PD after DEX. Median (IQR) scores for FAD and PD of the DEX group at baseline, day 8, and day 15 were 1.42(1.1,1.7),1.71(1.3,2.1),1.78(1.4,2.2); [1.1(0.8,1.4); 1.38(.04,1.6); 1.43(1.3,1.7) respectively and significantly correlated over time at Day 8 (r = 0.76; p < 0.001) Day 15 (r = 0.55;p < 0.001) [FAD]; Day 8 (r = 0.36; p < 0.001) Day 15 (r = 0.45; p < 0.001) [PD]. Conclusions: FAD cluster showed improvement with dexamethasone and consistent correlation overtime, as compared to SAD and PD cluster. These findings suggest that fatigue-anorexia/cachexia- and depression share a common a common pathophysiologic basis. Further studies are needed to investigate this cluster and target anti-inflammatory therapies. Clinical trial information: NCT00489307.
Impact of opioid use on survival in patients with newly diagnosed stage IV non-hematologic malignancies.
Authors: Zylla Dylan Michael , Richter Sara , Shapiro Alice C. , Gupta Pankaj 
Published: February 2017

188 Background: Pain is a challenging problem in patients with advanced cancers. Opioids are commonly required to treat cancer-related pain, but may be associated with tumor progression and shorter survival. We recently reported that high opioid use during the first 90 days after diagnosis is associated with shorter survival in patients with advanced lung cancer. Methods: We identified 1386 newly diagnosed stage IV non-hematologic malignancies from 2005-2013 and gathered pain and opioid utilization within 90 days of treatment using data from electronic medical records and the tumor registry. Opioid utilization was stratified into low opioid exposure (LOE; no opioid prescriptions or one prescription for a short-acting opioid) and high opioid exposure (HOE; any long-acting opioid prescription or 2 or more short-acting opioid prescriptions). Pain was analyzed by the proportion of time patients reported levels of moderate-severe pain (i.e., pain level ≥ 4). The effects of opioid exposure, prognosis of tumor type ( < 1 year vs ≥ 1 year), and gender on overall survival were analyzed in univariable and multivariable models. Results: Patients in the HOE (n = 887) and LOE (n = 499) groups were well matched for age, gender, and tumor type. Moderate-severe pain was higher in the HOE group compared to the LOE group (29.3% vs 14.0%). HOE was associated with shorter median survival compared to LOE (7.2 vs 13.2 months, p-value < 0.0001). On multivariable analysis, HOE was associated with shorter overall survival after adjusting for age, gender and tumor prognosis (HR 1.4, 95% CI 1.2- 1.6) (Table). Conclusions: Results support prior studies of advanced prostate and lung cancers, and show early utilization of opioids is a strong prognostic factor for survival. Further prospective investigation on the role of opioid receptors and opioid utilization is urgently needed. [Table: see text]
Outcomes of hypofractionated palliative radiotherapy for choroidal metastases.
Authors: Hahn Ezra , Velazquez-Martin Juan Pablo , Somani Sohel , Salazar Pedro , Domville Daniela , Payne David , Xu Wei , Su Jie , Pavlin Charles , Simpson Rand , Laperriere Normand , Krema Hatem , Waldron John N. , Chung Caroline 
Published: February 2017

194 Background: External beam radiotherapy (RT) is an effective palliative treatment for choroidal metastases aimed at preserving vision and obtaining local tumor control. Delivery of 30-40 Gy in 2 Gy daily fractions is a standard approach in many centers. At our center, a shorter, more convenient schedule of 20 Gy in 5 fractions has been used in this palliative setting. This study reports the efficacy and toxicity of this hypofractionated RT approach. Methods: We conducted a retrospective review of patients treated in the Ocular Oncology clinic at Princess Margaret Cancer Center who received RT (20 Gy in 5 fractions) for choroidal metastases between January 1, 1999 and November 30, 2012. Primary outcome measures were change in visual acuity and tumor response. Secondary outcomes included toxicities of RT, tumor control, and overall survival from the date of choroidal metastases diagnosis. Results: A total of 55 patients with 71 involved eyes were included. Decreased vision was the presenting symptom in 43 eyes (61%). Visual acuity improved from a median of 20/70 to 20/40 between baseline assessment and last follow-up, and remained stable or improved in 56 eyes (80%). On ultrasound, tumor regression was observed in 64 eyes (91%) with complete response in 47 eyes (67%). Metastases progressed in 4 eyes (6%) despite RT with 1 eye requiring enucleation. Median survival after diagnosis of choroidal metastases was 13 months with estimated overall survival at 1, 2, and 3 years to be 50% (36-62), 23% (12-35), and 8% (3-18), respectively. Forty-nine patients (89%) did not experience any acute complications. Mild acute toxicities included transitory dryness in 5 patients and episcleritis in 1 patient. Cataracts developed in 4 eyes (6%), retinopathy in 1 eye, optic neuropathy in 7 eyes (10%), pigmentary maculopathy in 5 eyes (7%), and neovascular glaucoma in 1 eye. Conclusions: A short fractionation schedule of 20 Gy in 5 fractions is a well-tolerated treatment that effectively preserves vision and gains local tumor control for many patients with choroidal metastases. This hypofractionated approach would help reduce the burden of a longer treatment course in this palliative patient population.
Anticipating the needs of the neuro-oncology caregiver.
Authors: Page Margaretta S , Molina Idonah , Patt Judy , Chang Susan M 
Published: February 2017

228 Background: It is well documented that CGs of neuro-oncology patients have complex needs that vary across the disease trajectory. It has also been suggested that needs vary by individual and further work to better understand the expectations of support, as well as the timing and nature of support is needed. Methods: In September 2013, the UCSF Neuro-Oncology Division launched a program to specifically provide care to CGs. We focused initial efforts on the needs of CGs of patients with newly diagnosed glioblastoma (NDGBM) who were offered services over the first 4 months of the illness. For high risk (HR) patients characterized either at the time of progression or transition to hospice, CGs were offered services as much as needed after referral. The needs assessment spanned several domains. We report on the first 18 months of providing care to these two groups of CGs. Results: Of 65 CGs of NDGBM patients, 21% identified no needs, and of those that did, 52% had more than one need. 82% of 144 CGs of HR patients had multiple needs. Both groups had highest needs around emotional support and advocacy, with the HR CGs expressing significant higher need for emotional support at 80%. HR CGs had higher percentage of needs when compared to the NDGBM CGs around obtaining caregiver resources ( 42% vs. 28%), family relations (30% vs. 11 %), health care navigation and obtaining psychological services (26% vs. 6 %), and health information (21% vs. 8%). Conclusions: CGs express the need for increasingly complex support as the illness progresses with a differential demand compared to the time of initial diagnosis. This suggests that developing specific modules of care for high demand needs throughout the trajectory of the illness will improve the QOL of CGs of neuro-oncology patients.
Value of help from someone who's been there.
Authors: Schultz Debbie McCally , French Susan Penn 
Published: February 2017

241 Background: Cancer patients want to speak with someone who has their diagnosis, treatment or experience; but speaking with someone before an ostomy surgery, pelvic extenteration or the Whipple procedure, etc. can be particularly helpful due to the increased anxiety related to these and other serious procedures. A custom peer mentoring program by the cancer center for diagnosis or serious treatment purposes is optimal. Clinicians and patients want the service and attest to the importance of a one-on-one support connection. Methods: Steps were taken to partner with clinicians feeling peer support would be important to their patient. They want to make the best connection possible in a timely manner. Clinicians worked with the psychosocial program offering support to customize the connection so it would match the patient’s next treatment step. Peer mentors were recruited and trained to deliver a motivational interview style of approach in speaking with others who have the same cancer treatment experience. Mentors share resiliency tips they have developed or have found helpful. Results: MD Anderson Cancer Center’s Volunteer Services department offers a One-on-One support program of trained survivor volunteers available to support other survivors. The program has become a valued psychosocial offering by the MD Anderson. The clinicians and Volunteer Services staff team together to create a specific type of peer mentoring for a serious treatment or procedure or diagnosis. The volunteer staff department administers the One-on-One support program by recruiting, training and making available the connections when requested by clinician or patient. Currently, there are 1912 active survivor volunteers in the One-on-One support database. 2370 connections were made in FY14 and 1596 connections to date in FY15. Conclusions: Patients get support from survivors who have had the same experience at a time when their anxiety may be highest. Survivors who have lived through the same serious treatment and are hopeful and resilient after the procedures make the patient feel less isolated, frightened and supported by others. Caregivers, who often have more anxiety than the patient, welcome the support for their loved one.
Racial differences in suicide deaths after cancer diagnosis: A SEER-based analysis of 2,336,949 patients.
Authors: Chen Yu-Wei , Wu Chao-Ping , Chiu Yu-Han , Chang Angela Y. , Chen Chen-Hao , Feng Yen-Chen , Lin Sheng-Hsuan , Sheu Yi-Han , Lin Yen-Feng 
Published: February 2017

244 Background: Risk of suicide is increased after cancer diagnosis. Our study aims to investigate the racial differences on risk of suicide after cancer diagnosis in a nationwide cohort of U.S. patients. Methods: Patients ≥ 18 years and diagnosed with breast (n = 616,099; 26.4%), lung (n = 585,978; 25.0%), colorectal (n = 429,060; 18.4%), or prostate cancer (n = 705,812; 30.2%) from 1988-2010 in Surveillance, Epidemiology and End Results Program (SEER) were identified. A Cox-proportional hazard model was used to compare the suicide mortality of the races (Hispanic white, African American, Asian/Pacific Islander, American Indian/Alaska Native) to non-Hispanic white patients adjusting for age, sex, marital status, household income, education level and cancer sites. Results: A total of 2,336,949 patients were identified, and there were 3,406 suicide death events. Fifty percent of suicide deaths were within 32 months after cancer diagnosis (interquartile range: 66 months). After a median follow-up of 49 months, the suicide mortality was lower in African American (HR: 0.29, 95% CI: 0.25-0.35, p value <.0001), Hispanic white (HR: 0.49, 95% CI: 0.41-0.58, p value <.0001), Asian/Pacific Islander (HR: 0.67, 95% CI: 0.57-0.79, p value<.0001). The suicide mortality was the same comparing American Indian/Alaska Native to non-Hispanic white patients (HR: 1.01, 95% CI: 0.62-1.65, p value: 0.97). Conclusions: After adjusting for sociodemographic factors, non-Hispanic white cancer patients still had higher risk of suicide death after cancer diagnosis. Future studies should address the racial differences of psychological stress after cancer diagnosis. [Table: see text]
Empowering bereaved parents in the development of a comprehensive bereavement program.
Authors: Snaman Jennifer Malia , Phillips Charlene , Levine Deena R. , Baker Justin N. 
Published: February 2017

47 Background: The death of a child poses special challenges to both bereaved families and staff. Each individual's grief journey is unique and ongoing; however, common themes and support systems help to define successful bereavement services. Bereaved parents who have experienced the loss of a child have special insight and can help to identify the key components necessary for the development and implementation of a comprehensive bereavement program. Methods: The bereavement program at St. Jude Children’s Research Hospital is multifactorial and involves both supportive services and useful resources that have been developed by parents who have lost a child to cancer at our institution. Results: The program begins with anticipatory bereavement services prior to death by the bereavement coordinator and Palliative Care team. Following the child’s death, a bereaved parent mentor is offered and available. These mentors have been trained how to identity and triage abnormal or concerning behaviors and how to obtain additional psychosocial support for at risk families. The materials include a parent-created a resource manual with parent and sibling with recommended books, websites, and other helpful references. Parents developed a booklet containing reflective pieces and several videos describing difficult moments in their grief journey to provide a support to other parents, siblings, and staff. Finally, they designed and illustrated communication cards to be sent to all bereaved families at key time points during the first two years following a child’s death. Conclusions: The innovative nature of this program with multiple components of the parent-driven comprehensive bereavement program can serve as a paradigm for the development of others programs and for the field of hospice and palliative medicine as a whole.