bluuebunny/crossref_metadata_2025_split huggingface dataset:
Randomized trial of a cognitive-behavioral therapy mobile app for anxiety in patients with incurable cancer.
Authors: Greer Joseph , Jacobs Jamie M. , Pensak Nicole , MacDonald James J , Fuh Charn-Xin , Perez Giselle Katiria , Ward Alina , Holt Anne , Tallen Colleen , Muzikansky Alona , Traeger Lara , Penedo Frank J. , Safren Steven A. , Pirl William F. , Temel Jennifer S. 
Published: November 2017

175 Background: Patients with incurable cancer often experience marked anxiety that is associated with poor quality of life (QOL), high symptom burden, and complications with medical treatment. The aim of this study was to test the efficacy of a mobile app-based cognitive-behavioral therapy (CBT) intervention to treat anxiety symptoms in patients with incurable cancer. Methods: From 2/15 to 8/16, 145 patients with incurable cancers (e.g., advanced lung, breast, GI/GU, sarcoma, melanoma) who screened positive for at least mild anxiety symptoms (Hospital Anxiety & Depression Scale-Anxiety subscale, HADS-A > 7) were randomized 1:1 at two cancer centers to receive either the CBT mobile app for anxiety or a mobile health education program (control), delivered via tablet computers. The CBT app consisted of 7 modules teaching skills to relax the body, reduce worry, stay present-focused, improve communication, and plan/pace activities, which patients completed over 12 weeks. To assess anxiety, mood, and QOL, we administered the Hamilton Anxiety Rating Scale (HAM-A), Clinical Global Impression Scale (CGI), HADS, and Functional Assessment of Cancer Therapy-General at baseline and 12 weeks. General linear models were used to assess the effect of the intervention on patient outcomes over time. Results: The sample was predominantly female (73.8%) and white (91.7%), with a mean age of 56.45 ( SD= 11.30) years. Both study groups reported significant improvements in anxiety, depression, and QOL from baseline to post-assessment (all p-values < .002), with no differences in the improved outcomes between groups. Secondary analyses revealed interaction effects on anxiety between the intervention and baseline HAM-A scores. Among patients with higher baseline anxiety, those randomized to the CBT app had greater improvements on the HAM-A ( p= .043), CGI ( p= .048), and HADS-A ( p= .001) compared to the health education control group. Conclusions: Patients with incurable cancer who received either a CBT mobile app intervention or mobile health education program reported improvements in anxiety, depression, and QOL. However, the CBT mobile app had better outcomes than health education for patients with higher baseline anxiety. Clinical trial information: NCT02286466.
Selecting a prepared medical decision maker.
Authors: Zhukovsky Donna S. , Soliman Pamela T. , Mathew Boby , Mills Sarah , Bodurka Diane C. , Meyer Larissa , Westin Shannon Neville , Nowitz Marisa , Archie LaShan , Fenton Shauna , Lang Kai E. , Williams Janet L. , Boving Valentine 
Published: November 2017

18 Background: Selection and preparation of a medical decision maker (MDM) is key to person-centered advance care planning (ACP). ASCO’s Quality Practice Oncology Initiative recommends that all new patients (pts) discuss advance directives or ACP by the third office visit (OV). Methods: We collected baseline data from 9/8/16-12/31/16 for all new pts presenting with invasive malignancy to 4 gynecologic oncologists. A patient needs survey (PNS) was conducted at the 1st OV to evaluate if pts had completed a medical power of attorney (MPOA) & pt desire for additional assistance with advance directives (AD) or ACP. Electronic health records (EHR) were reviewed for the 1st 3 OV to determine disease status, presence of scanned MPOA and nature and type of ACP notes, including documentation of MD/advance practice provider (MD/APP) discussion of MPOA, social work (SW) MPOA counseling & elements suggesting selection of a prepared MDM. Pearson Chi-Square or Mann-Whitney U test were used for comparisons, as appropriate. Results: Of 150 women, disease status was available for 133 (91%). Data presented are for pts with known status. Median (range) number of visits was 2 (1-3). 29% reported having an AD, but only 11% had a MPOA in the EHR. (See Table). Conclusions: Our data suggest that current processes do not successfully capture the majority of already completed MPOA, most pts do not perceive the relevance of selecting a prepared MDM and that most named MDMs have not been well prepared. Other than for visit #, there were no significant differences by disease status. Future QI cycles will focus on more active pt engagement. [Table: see text]
Association of anxiety and depression concerns with overall levels of patient reported distress during radiotherapy.
Authors: Landy Robin , Whitaker Dale Alan , Jagadesh Niveditha , Strong Gerald , Chimato Nicolette , Heckman Michael , Kaleem Tasneem , Buskirk Steven J. , Vallow Laura , Tzou Katherine S. , Ko Stephen , Peterson Jennifer Layton , Day Atiya , Nelson Kimberly , Habboush Jacob , May Byron C. , Miller Robert Clell 
Published: November 2017

182 Background: The purpose of this study was to examine the associations of three different measures of anxiety and depression with patient reported distress (PRD) level and survival after radiotherapy (RT). Methods: 518 patients who underwent RT between 2012 and 2016 were included in this retrospective study. PRD was assessed at the time of RT using the NCCN thermometer and a 30 question survey of distress related items. PRD and clinical and demographic data was retrospectively collected and analyzed. The three measures this study focused on that assessed patient anxiety and depression involved asking patients about their level of concern regarding feeling down, regarding loss of interest, and regarding feeling nervous. Associations between baseline patient characteristics and survival after start of RT were evaluated using single variable Cox proportional hazards regression models. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated. Associations of level of concern regarding patient anxiety/depression with survival after RT were evaluated using single variable and multivariable Cox proportional hazards regression models. Results: Overall, PRD level and concern regarding anxiety/depression were positively correlated (p < 0.001). Additionally, there was a significant association between level of concern regarding feeling down and palliative patients (p = 0.03). There was also a significant association between level of concern regarding loss of interest and palliative patients (p = 0.03), with level of concern highest for thorax, breast, and head and neck. There was also a significant different between level of concern regarding feeling nervous and gender (p = 0.05). There was not a significant difference between any of the three measures and survival after RT (all p ≥ 0.21). Conclusions: Anxiety and depression in patients receiving palliative and curative RT was associated with overall distress. Baseline screening of PRD may identify patients who would benefit from intervention to address the causes of their underlying anxiety and depression.
Perceptions of stress in adolescent and young adult (AYA) cancer patients and survivors in Kansas City, KS, and Copenhagen, Denmark: A pilot study.
Authors: Elsbernd Abbey , Crenner Christopher , Boisen Kirsten , Bækgaard Larsen Hanne , Hjerming Maiken , Loew Thomas W. , Rosell Tarris , Panicker Jyoti 
Published: November 2017

186 Background: Adolescent and Young Adult (AYA) Oncology is a developing field of medicine with unique challenges in the clinical setting. People at this stage of life face many difficulties, which may be compounded by lack of insurance coverage and barriers in accessing health care resources. The goal of this pilot study is to examine how stress levels and psychosocial well-being are affected by healthcare system, insurance status, and other AYA-specific factors. Methods: 38 AYA patients ages 15-30 who have received, or are currently receiving treatment for an oncology diagnosis completed an online survey and 10-item interview, with 29 patients at University of Kansas Medical Center, Kansas City, United States, and 9 patients at Rigshospitalet, Copenhagen, Denmark. Survey measures included the Perceived Stress Scale (PSS) standardized tool, and questions relating to patient concerns, resources utilized, and general thoughts on healthcare. Results: Differences in quantitative stress levels were not significant between the two study sites. In Kansas City, female gender was identified as a significant variable for increased PSS values. In addition, Kansas City patients expressed increased reported practical concerns, such as the role of social workers, transportation, insurance, and disruptions in work and school life due to treatment. Danish patients expressed more positive practical concern statements, citing Danish government resources such as physical therapy and psychiatry services. Qualitative data for both sites placed highest emphasis on the connection that AYA patients have with their healthcare team. Both U.S. and Danish patients reported diverse concerns and positive experiences. Conclusions: AYA oncology patients are a diverse group who have not yet been sufficiently studied, and face many struggles that are unique to this age group. More research on a broad scale is needed, as the data collected in this study suggest results that may prove significant with more time available and larger patient sample sizes. The first author of this abstract has been selected as a semifinalist by the Fulbright commission to expand this pilot project in 2017-2018.
Geriatric syndromes and association with distress in older cancer patients.
Authors: Sanders Barton J. , Huang Chao-Hui , Rocque Gabrielle Betty , Williams Grant R , Pisu Maria J , Kenzik Kelly , Kvale Elizabeth Ann 
Published: November 2017

189 Background: Geriatric syndromes are multifactorial conditions affecting the elderly that are associated with decreased quality of life and poor outcomes. We sought to quantify the prevalence of geriatric syndromes in a group of navigated cancer patients and identify conditions associated with distress. Methods: Distress assessments were conducted between January 2012 and December 2015 on enrollment into the PCCP, a lay-navigation program that serves Medicare recipients in the UAB Health System Cancer Community Network. Assessments were made using a modified Distress Tool, which captures sources of distress in multiple domains. We identified questionnaire items related to common geriatric syndromes including functional decline, sensory impairment, cognitive and mood changes, sleep problems, incontinence, pressure ulcers, and malnutrition. Prevalence of geriatric syndromes was indicated by reported distress for an item that mapped to one of the above syndromes. Results: 8,014 patients were surveyed; 53 % of patients were 65- 74 yoa with 47% > 74 yoa while 52% were female. The most common cancer types were breast (18%), lung (17%), and gastrointestinal (16%). Of all surveyed patients, 1,779 (22%) reported distress related to at least one geriatric syndrome. The most common complaint was decline in functional ability relating to ADLs (11%) and IADLs (7%). Conclusions: Geriatric syndromes, such as functional disability, contribute to distress in older patients with cancer patients. Early screening and identification may lead to timely intervention to help improve quality of life. Further research is needed to describe the relationship between these syndromes and health outcomes, such as their association with health care utilization in older adults with cancer.
Predictors of quality of life in non-muscle-invasive bladder cancer survivors.
Authors: Jung Ahrang , Crandell Jamie , Nielsen Matthew Edward , Smith Sophia Kustas , Palmer Mary H. , Bryant Ashley Leak , Mayer Deborah 
Published: November 2017

193 Background: Non-muscle-invasive bladder cancer (NMIBC) survivors face frequent invasive surveillance cystoscopies, repeated treatment, and the highest recurrence rates and medical cost among all cancer survivors for the remainder of their lifespan. Despite the burdens of survivorship for this group, very little is known about the quality of life (QOL) impact of NMIBC diagnosis. We identified factors associated with QOL in NMIBC survivors. Methods: 2000 patients were randomly selected from the 5979 NMIBC population diagnosed between 2010-2014 in North Carolina. These patients received a mailed survey including cancer-specific (EORTC QLQ-C30) and NMIBC-specific (QLQ-NMIBC24) measures of QOL. QOL in this population was described, and hierarchical multiple linear regression was used to determine which patient and disease characteristics are associated with QOL. Results: 376 survivors were included in the analyses (response rate 22%). The mean QOL scores for the following domains include (range 0- 100, higher score is better in all domains but symptoms): global health 73.6±21.7, function 84.8±18.5, symptoms 15.5±17.2, NMIBC-specific sexual function 31.5±27.1 and NMIBC-specific sexual enjoyment 48.1±38.1. Survivors reporting significantly lower global health status were more likely to be male (p < .01), lower income (p = .02), stage Tis at diagnosis (p < .01), and have lower cognitive abilities (p < .01). Lower function (p < .01) and higher symptoms (p = .01) were seen in survivors who were not cured or unsure whether were cured (vs. cured). Lower global health status (p < .01) and higher symptoms (p < .01) were found in survivors who had not received intravesical immunotherapy. Lower social support was associated with lower global health status (p < .01) and lower function (p < .01). A higher number of comorbidities and more cognitive general concerns were associated with poorer QOL in all domains (all p < .01). Conclusions: We identified correlates of QOL in NMIBC survivors. Special attention should be given to those with high risk of lower QOL, including patients with more comorbidities, more cognitive general concerns, or lower social support.
Suicide risk in persons with colorectal cancer: A population-based study.
Authors: Deng Aileen , Basu Mallick Atrayee 
Published: November 2017

196 Background: Patients with cancer have nearly twice the incidence of suicide compared to the general population. To date, identifying patients at risk for suicide remains challenging. Colorectal cancer (CRC) is the third most common cancer in the US. The purpose of this study was to identify risk factors associated with higher suicide rates (SR) among patients with CRC. Methods: A retrospective analysis was completed using Surveillance, Epidemiology, and End Results data from 1973 to 2014. Comparisons with the general US population were based on US mortality data collected by the National Center for Health Statistics. Suicide incidence, rates and standardized mortality ratio (SMR) were obtained by SEER*Stat 8.3.4. Results: Among 414788 patients with CRC observed for 2785811 person-years, 747 suicides were identified, for an adjusted SR of 26.7/100,000 person-years (SMR 1.40 [95% CI 1.30-1.50]). Higher SRs were associated with male sex, non-white or non-black race, being unmarried and having advanced disease at diagnosis (Table 1). SR was highest in the first year after diagnosis (SMR 2.00 [95% CI 1.68-2.37]) and with increasing age at diagnosis among unmarried patients. In patients 60 to 64 years at diagnosis, SR was highest in unmarried men (SMR 3.72 [95% CI 2.61-5.15]) and lowest in married women (SMR 0.61 [95% CI 0.17-1.57]). Conclusions: CRC is one of the most common cancers in the US. Patients with CRC have a 1.5-fold increase in SR compared to the general population. Suicide screening should especially target those in their first year after diagnosis, particularly older, unmarried patients. [Table: see text]
Perceptions on the effect of physical activity on quality of life, overall survival, and fatigue in palliative cancer patients.
Authors: Balaratnam Karmugi , McFarlane Graham , Selby Peter , Alibbhai Shabbir , Brown M. Catherine , Jones Jennifer M. , Howell Doris , Pringle Dan , Xu Wei , Liu Geoffrey , Eng Lawson 
Published: November 2017

198 Background: Physical activity is an important lifestyle recommendation for all patients’ wellbeing. With better cancer treatments and palliative patients living longer, maintaining physical activity is becoming an important survivorship goal, even in the palliative setting. We assessed cancer patient’s perception of the effect of physical activity on their quality of life, overall survival, and fatigue. Methods: In a cross-sectional survey across all cancer sites, patient perception of the effect of physical activity on three outcomes: quality of life, overall survival, and fatigue. Palliative status was determined by chart review and primary oncologist assessments. Regression-based estimates of the odds ratios and confidence intervals (CI) described any differences in perception between palliative and non-palliative patients. Results: Of 1283 patients recruited, 1080 completed the entire survey; median (range) age was 58 (18-98) years; 54% were female; 15% were palliative. Palliative patients were less likely than non-palliative patients to believe that physical activity improved overall survival, with an odds ratio of 0.53 (95%CI 0.34-0.83; P = 0.006). Palliative patients were less likely to perceive that physical activity improved fatigue, with odds ratio 0.68 (95%CI: 0.47-0.97; P = 0.04). Although not statistically significant, palliative patients also perceived less of a positive effect of physical activity on quality of life with an odds ratio of 0.65 (95% CI 0.47-0.97; P = 0.12). Results were similar regardless of whether patients were asked to perceive the effect of physical activity on themselves or in the general cancer patient. Conclusions: Palliative patients were more likely to believe that physical activity did not improve their overall survival and fatigue compared to the curative counterparts. Also, there was no significant difference in the perception of the effect of physical activity on the quality of life among the two groups of cancer survivors. Since palliative patients are living longer, future research can focus on implementing exercise recommendations and following up so the actual benefits can be seen.
Who, what, where, when, and how? Advance care planning documentation practices and accessibility in the electronic health record.
Authors: Walker Evan Justin , Mcmahan Ryan , Barnes Deborah , Katen Mary , Lamas Daniela , Sudore Rebecca 
Published: November 2017

2 Background: Documenting patients’ advance care planning (ACP) wishes is essential to providing value aligned care, as is having this documentation readily accessible. Early ACP is increasingly being recognized as integral to oncologic care, however, little is known about current documentation practices. In this cross-sectional study, we describe ACP documentation practices and accessibility of documented ACP discussions in the electronic health record (EHR). Methods: Participants were recruited from outpatient clinics at the San Francisco VA, were ≥60 years old, with ≥2 chronic/serious conditions and ≥2 primary care visits in the past year. ACP documentation was abstracted from the EHR in 2013-2015 and included any prior legal forms/orders and ACP discussions documented within the prior five years. Frequency and type of ACP documentation was calculated using percentages and means. For discussions, author discipline and location of documentation was determined. Discussions were deemed “accessible” if documented in a designated ACP posting location or “not easily accessible” if recorded as free text in progress notes. Results: The mean age of 414 participants was 71 years (SD ± 8), 9% were women, 43% were non-white, and 51% had documented ACP including 149 (36%) with ACP forms and 138 (33%) with ACP discussions. Seventy-five (54%) discussions were documented by social workers and 49 (36%) by primary care providers. However, 76 (55%) discussions were not easily accessible. For 27 (18%) participants with advance directives, subsequent discussions documented a change in treatment preferences. Nineteen (70%) discussions reporting a change in wishes were not easily accessible. Conclusions: Half of chronically ill, older patients had documented ACP wishes, including a third with documented ACP discussions. Most discussions were documented by social workers and were not easily accessible, although discussions often represented changes from prior advance directives. Clinician education and EHR changes to ensure documented discussions are accessible are important patient-safety and quality improvement targets to ensure patients’ wishes are honored.
Effectiveness of an advance care planning patient navigator on advance directive completion by electronic versus staff-based referrals at a major cancer hospital.
Authors: Ito-Hamerling Gayle , Emanuel Lindsay , Zachariah Finly 
Published: November 2017

20 Background: Advance Care Planning (ACP) is a central component of patient-centered care, helping ensure patient values and preferences guide clinical decisions. Patient navigators have been utilized effectively in healthcare for numerous roles, and more recently for ACP. At City of Hope National Medical Center (COH), an ACP-focused navigator was hired to support patients, families, and staff with Advance Directive (AD) notarization and primary ACP conversations. Methods: The Department of Supportive Care Medicine at COH with significant institutional collaboration and administrative support created a patient-centered ACP program and marketing campaign, called “Plan Today for Tomorrow.” In 2016, an ACP navigator joined the team to facilitate AD completion. Referral to the ACP navigator occurred either through staff endorsement and/or the institution’s technological screening platform deployed in a majority of COH outpatient clinics. Staff referrals came from physicians, clinical social workers, nurses, or from the Sheri & Les Biller Patient and Family Resource Center. Prior to the ACP navigator, all referrals were addressed by Clinical Social Workers (CSWs). Results: In a review of 14 months of data, the ACP navigator followed up on 1,125 referrals, 574 were from staff, while 551 were from the institutional tablet-based screening platform. Follow-up on staff referrals resulted in an 86% AD completion rate. Follow-up on tablet-based screening resulted in a 23% AD completion rate. Conclusions: The presence of an available onsite ACP-focused navigator was more effective in facilitating AD completion of staff generated AD referrals as compared to AD completion of tablet-based patient screening AD referrals. The presence of the ACP navigator to facilitate AD completion decreased workload for CSWs, creating increased opportunity for CSWs to work at the top of their professional license. Further work is needed to increase the effectiveness of AD completion from tablet-based screening referrals.