bluuebunny/crossref_metadata_2025_split huggingface dataset:
Symptom clustering among patients visiting a supportive oncology clinic.
Authors: Wrammert Kathryn C. , Harrell Gwendolynn , O'Neill Michael , Grandhige Anjali , Moulia Danielle , Aktas Aynur 
Published: February 2017

188 Background: Multiple symptoms are common and often severe in patients with cancer. Identification of symptoms which cluster may serve to elucidate the pathophysiology of the disease and aid in symptom management. Our aim was to define symptom clusters occurring among cancer outpatients receiving chemotherapy. Methods: New and returning patients referred to a supportive oncology clinic (SOC) from our health system’s oncologists from November 2011 through May 2014 completed the Condensed Memorial Symptom Assessment Scale plus a sexual dysfunction structured assessment. Data were collected prospectively from 323 consecutive initial visits. Patients rated from 0-4 how bothersome 15 cancer symptoms were; symptoms were then graded as present (1+) or absent (0). Hierarchical cluster analysis with average linkage was used to identify symptom clusters. The absolute value of the correlation between symptoms was used as the measure of similarity between pairs of symptoms. A correlation of ≥0.6 was used to define the final clusters. A symptom cluster was defined as two or more symptoms that predictably occur together. Results: Three clusters were identified: 1. Psychological (worrying, feeling sad, feeling nervous); 2. Treatment-related (lack of energy, feeling drowsy, difficulty concentrating, dry mouth, constipation); 3. Gastrointestinal (weight loss, lack of appetite, nausea). Pain, difficulty sleeping, shortness of breath, and loss of interest did not cluster with any symptom. Gastrointestinal symptoms are important within the clusters. The prevalence of worrying, feeling sad, and feeling nervous did not cluster with lack of energy or difficulty in sleeping, nor pain with worrying or feeling sad. Conclusions: Three symptom clusters were identified as showing high absolute correlation: a psychological cluster, treatment-related cluster, and gastrointestinal cluster. Identifying symptom clusters may promote our understanding of the pathophysiology of cancer, help prioritize effective pharmacotherapies, and identify drugs likely to help more than one symptom.
Association between feeling of well-being and overall survival in advanced lung or non-colonic gastrointestinal patients receiving palliative care.
Authors: Yennu Sriram , Kim Yu Jung , Zhang Yi , Park Ji Chan , Hui David , Kang Duck- Hee , Arthur Joseph , Chisholm Gary B. , Williams Janet L. , Reddy Suresh K. , Bruera Eduardo 
Published: February 2017

199 Background: The aim of this study was to determine the association between feeling of well-being (FWB, 0= best, 10= worst) and overall survival in advanced lung or non-colonic gastrointestinal patients who were referred to an outpatient palliative care clinic (OPC). We also determined the predictors of severity of moderate or severe - feeling of well-being in advanced lung or non-colonic gastrointestinal patients presenting to palliative care. Methods: We reviewed the records of consecutive patients with incurable advanced lung cancer and non-colonic gastrointestinal cancer presenting to OPC. Edmonton Symptom Assessment System (ESAS) scores were obtained at the initial visit between from Jan. 1, 2008-Dec. 31, 2013. Descriptive statistics were used to summarize patient characteristics. Clinically significant FWB was defined as ≥4/10. Overall Survival (OS) was calculated from the time of diagnosis of advanced cancer to death or last contact. Univariate analyses were performed and only significant variables were included in multivariate regression analysis to determine factors associated with severity OF FWB. Results: A total of 826 evaluable patients were analyzed (median age, 62 years; 57% male). Median ESAS FWB scores was 5 IQR (3-7). Worse FWB was significantly associated with OS (months) 6.33 (5.03, 8) vs 4.2 (3.37, 4.67) P=0.0003, from the time of diagnosis of advanced cancer. The final model of the Backwards Stepwise regression of factors associated with OS found that FWB (HR 1.09, p=0.3) was not an independent predictor of OS. ESAS FWB was significantly associated with ESAS fatigue (OR 2.31, p<0.001); anxiety (OR 1.98, p<0.001); anorexia (OR 2.31, p<0.001); CAGE positivity [alcoholism] (HR 1.80, p=0.008); and family distress (HR 1.93, p=0.002). Conclusions: Worse ESAS FWB showed univariate association with OS but it does not appear to be an independent predictor of OS when controlling for other known predictors. ESAS FWB was significantly associated with fatigue, anxiety, anorexia, CAGE positivity, and family distress, suggests that ESAS FWB may be a multidimensional screening measure for patient reported health related quality of life.
Infrastructure to improve together: Fostering palliative care (PC) and quality improvement (QI) learning in oncology through a virtual learning collaborative (VLC).
Authors: Kamal Arif , Prestrud Ann Alexis , Ast Katherine , Bruno Julie , Gavigan Molly , McNiff Kristen K. , Abernethy Amy Pickar , Von Roenn Jamie H. 
Published: February 2017

20 Background: PC and oncology teams can most effectively improve patient experience during cancer when the specialties improve care processes together through collaborative QI activities. To support collaboration ASCO, the American Academy of Hospice and Palliative Medicine, and Duke University developed a partnership to pilot the ASCO VLC. This pilot will develop and test a scalable model for quality improvement and dissemination of best practices, focused on improving palliative care in oncology. Methods: The ASCO VLC integrates lessons learned through the Breakthrough Series, ASCO Quality Training Program, and others. An Advisory Committee representing expertise in medical oncology, palliative care, geriatrics, nursing, social work, survivorship, health services research, and quality improvement oversees the pilot project. Content in the VLC website was refined based on feedback gathered through a needs assessment survey of pilot participants. Results: The online collaborative and learning platform went live in June 2014. The site houses live and recorded educational sessions covering PC and QI topics, includes discussion boards to foster interactions between practices, supports sharing of tools and resources, and allows practices to submit their problems and aims statements, and results of their work for peer review and feedback. 24 practices were recruited to participate; 73% from community/private practice sites. In response to the needs assessment, 85% of participants responded with a high sense of comfort with PC; yet, only 33% had similar comfort with QI. When asked to rank their top preference, respondents were most interested in learning about pain and symptom management (44%), or advance care planning (22%). Ongoing mixed qualitative and quantitative assessments through Spring 2015 will assess feasibility and acceptability of the ASCO VLC model. Conclusions: We are creating an online virtual learning collaborative as a sustainable infrastructure to support and foster clinician education and dissemination of PC best practices in oncology.
Pain score, analgesic utilization, and patient satisfaction among cancer patients at a community cancer center.
Authors: Zylla Dylan Michael , Fulbright Jim , Pawloski Pamala A. , Illig Lisa , Peck Adina , Van Peursem Sarah , Richter Sara , Larson Amber 
Published: February 2017

203 Background: Cancer-related pain is common, negatively impacts quality of life and survival, and often requires opioid analgesics. Patient level data describing the incidence and severity of pain, medication utilization, and patient satisfaction associated with care are lacking. An understanding of cancer pain prevalence and analgesic utilization is needed to initiate quality improvement (QI) interventions. Methods: We analyzed 2 months of outpatient oncology clinic encounters from the electronic medical record (EMR) and conducted a patient survey of 163 cancer patients to obtain baseline data on pain levels, opioid and non-opioid treatments, and patient satisfaction. Our survey incorporated questions from the Brief Pain Inventory to validate EMR reports and obtain patient satisfaction data. Results: Moderate to severe pain is reported in nearly 1 of every 9 cancer patient encounters (Table 1). On average, we achieved a personal pain goal (PPG) in 83.5 % of all patients (n=109). Among patients receiving opioids, a PPG was achieved in 16 of 29 patients (55.2%). Of the 13 opioid-consuming patients not achieving a PPG, 12 were not on a long-acting opioid, and 5 had never discussed a pain management plan with their physician. Oxycodone CR is the most commonly prescribed long-acting opioid (40.4% versus morphine SR (26.1%), methadone (23.0%), and fentanyl transdermal (10.6%)). Conclusions: Moderate to severe pain is commonly encountered among patients receiving cancer care in the clinic setting. Increasing the proportion of patients achieving a PPG is a critical quality and patient satisfaction goal, and may be improved by creating a pain plan incorporating a long-acting opioid. Our QI intervention aims to improve pain assessment documented in the EMR and educate both patients and staff regarding appropriate pain management. [Table: see text]
Reduced symptom burden after visiting an outpatient supportive oncology clinic.
Authors: Wrammert Kathryn C. , Harrell Gwendolynn , O'Neill Michael , Grandhige Anjali , Binney Zachary O. , Quest Tammie E. 
Published: February 2017

204 Background: Outpatient palliative care in supportive oncology clinics (SOC) is growing and has shown promise in controlling symptoms. We sought toinvestigate the impact on symptom burden of a SOC in a National Cancer Institute-designated Comprehensive Cancer Center. Methods: New and returning SOC patients referred from our health system’s oncologists from November 2011 through May 2014 completed the Condensed Memorial Symptom Assessment Scale plus a sexual dysfunction structured assessment. Visits include a structured symptom assessment and personalized treatment plan from the clinic’s part-time physician and/or nurse practitioner. Patients rated from 0-4 how bothersome 15 cancer symptoms were. Descriptive statistics were calculated. We used the Wilcoxon signed rank test to compare symptom scores at patients’ first and second visits. Results: 135 patients had multiple SOC visits. Mean age was 54.7 (SD 12.5) years. 55.3% were female. The most common cancers were breast, lung, and head and neck (18.1% each). Median time between visits was 29 days (mean: 52.8, range: 2-446). The most bothersome symptoms at baseline were pain (mean 3.1, SD 1.3), lack of energy (2.4, SD 1.3), and difficulty sleeping (2.1, SD 1.6). Least bothersome were dyspnea (0.8, SD 1.1), sexual problems (0.9, SD 1.4), and nausea (1.0, SD 1.3). Energy, pain, drowsiness, constipation, sleep, worrying, sadness, and nervousness were significantly improved at follow-up with reductions between 0.2 (drowsiness) and 0.5 (pain) points (all p<0.05). Weight loss trended toward improved (p=0.053). Conclusions: 8 of 15 symptoms significantly improved after the first visit to a small-scale SOC. These reductions may underestimate the SOC’s effect if disease was progressing or overestimate differences if disease was shrinking, but such data were unavailable. Larger multi-site trials with well-defined interventions and control groups are needed.
A study of in-patient oncology satisfaction.
Authors: Moka Nagabhishek , Jubelirer Steven , Welch Christine A. , Taylor Martha B. 
Published: February 2017

205 Background: The European Organization for Research and Treatment in Cancer (EORTC) developed the EORTC-IN-PATSAT32 survey for in-patient satisfaction (use permission granted). Methods: The EORTC-IN-PATSAT32 survey administered after consent, at discharge on an oncology floor at a large university affiliated community hospital. Comparisons were made to Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), which were collected during the same time period. Results: The average age of those completing the 282 surveys was 60.2 ± 12.3. Males made up 50.2% of the population, 96% were Caucasian, 66% were married, and 49% had a high school education or less, 4% were enrolled in a clinical trial and 75% had researched illness on the internet. Physicians and nurses were ranked highest for there technical skill 90 ±16 and 87±17, respectively and lowest for their availability, 85±2 and 81±24, respectively. The services and care organization was ranked highest for other hospital staff interpersonal skills, 80±20 and lowest for hospital access, 70±25. Even though 87% of the population ranked there overall stay as very good or excellent there were differences seen between groups. Males were more satisfied with the information they received about care (p = 0.04), and their overall hospital stay (p = 0.03) than females. Patients treated by a medical oncologist were more satisfied with the information the received (p = 0.03) compared to other specialties. Married patients found access to facilities was better (p = 0.03) than unmarried patients. Those ≥ 65 were more satisfied with the exams, interest, and comfort of the nursing staff (p =.03) than their younger counterparts. HCAHPS (always rank) was higher than EORTC (excellent rank) for information (p <.0001), personnel listening ( p < 0.0001), and hospital cleanliness (p = 0.008), however no difference was seen in overall rating of care (p = 0.45). Conclusions: The majority of patients were satisfied with their care. Patients gender, marital status, age and the specialty of the physician were significant factors in determining satisfaction. Survey administration differences may contribute to difference between EORTC and HCAHPS. Hospital staff need to be cognizant of possible unintended bias towards various groups of patients.
Pattern of microbial organisms in radiation induced mucositis and dermatitis in head and neck squamous cell carcinoma (HNSCC) treated with radiation (RT)/chemo radiation (CTRT).
Authors: Venkatesulu Bhanu Prasad , Mallick Supriya , Ventrapati Pradeep , Roshan Vikas , Bhasker Suman , Rath Goura Kisor 
Published: February 2017

210 Background: Mucositis and dermatitis complicated by bacterial and fungal infections are common in patients undergoing RT/CTRT. We intended to assess spectrum of microbial organisms in skin and oral swabs, rationality of antibiotics/anti-fungal (AB/F), toxicities, hospitalization and treatment delays. Methods: This was a prospective, single arm observational study conducted in a tertiary care hospital. 25 patients undergoing RT or CTRT from January 2014 to June 2014 were included. Patients were subjected to skin-wound and oral swab gram stain, potassium hydroxide mount, bacterial and fungal culture with sensitivity. Results: Median age was 54 years (30-69). Male: female ratio 1.5:1. Primary site: tongue 5 (20%), palate 5 (20%), tonsil, pyriform-sinus 4 (16%) each, buccal-mucosa, alveolus 2 (8%) each, EAC, nasopharynx, RMT one each (12%). 24 2D (96%) and 1 (4%) 3D planning. Feeding tube required for one (4%). 16 received concurrent cisplatin (40mg/m2 weekly), median 3 cycles. At median dose 48 (16-68 Gy) patients were referred for toxicities. Grade III,IV dermatitis were in 5(20%), 1(4%) respectively.Grade III,IV mucositis was 5(20%), 0(0%) respectively. Median laboratory parameters: hemoglobin 10.5, TLC 6350, albumin3.6 and globulin 2.8. Spectrum of organisms isolated is tabulated below. In GPC, specific isolate was Methicillin sensitive staphylococcus aureus 2, beta hemolytic streptococcus one. Four required i.v antibiotics. 3 received i.v ciprofloxacin 200mg BD and i.v metronidazole 500mg TDS, one required i.v cefoperazone-sulbactam 2 gm BD (7 days); rest 21 had adequate relief with topical antibiotics (metronidazole TDS) or antifungal (clotrimazole mouth paint TDS) alone for 7 days. Median duration of hospital stay was 10 days (2-16). Treatment interruption was in 6 ranging 6-10 days. Conclusions: Topical AB/F with adequate hydration can provide adequate symptom relief and avoid treatment interruption for mucositis and dermatitis. [Table: see text]
Venous thromboembolism: What pharmacists know? What do they need?
Authors: Rey Jean-Baptiste , Kreit Pierre , Sicard Jerome , Parent Damien , Jovenin Nicolas , Hettler Dominique , Nguyen Philippe , Ducrocq Jean-Luc 
Published: February 2017

212 Background: Venous thromboembolism is frequent in cancer. Low molecular weight heparins (LMWH) are recommended for prevention/treatment of thrombosis in cancer. Community pharmacists are very often faced with patients' questions (dosage, tolerance, treatment duration). The aim of this study was to assess the community pharmacists' knowledge regarding 'thrombosis in cancer'. Methods: A web-questionnaire (built by a multidisciplinary group) was open between October and November 2013 to community pharmacists in Champagne-Ardenne region. Collected data were 1) pharmacy's general organization for cancer patients' management, 2) management of ambulatory patients with 'thrombosis and cancer' and 3) pharmacists' knowledge assessment through a simple case report: after an initial 10-days hospital prescription, what should a patient receive as anticoagulant treatment? Results: 180 (38%) community pharmacists answered the questionnaire. Among those, in 65%, the number of patients with cancer was 6-15/pharmacy. In 70% the number of patients with thrombosis and cancer was 1-10/pharmacy. In 93%, the pharmacists had no specific competency in oncology and/or supportive care. Moreover, 96% were not aware of the existence of national/international recommendations regarding 'thrombosis in cancer'. At last, only 49% gave the correct answer to the case report (LMWH). The most expressed needs were information, continuous education, and information booklets for patients. Conclusions: This regional questionnaire is currently extended to all French regions. Continuous education sessions are being put in place. Another questionnaire will be launched at the end of 2014 to assess education sessions' efficacy.
Outcome of patients malnourished at diagnosis of a metastatic lung adenocarcinoma.
Authors: Vansteene Damien , Hiret Sandrine , Senellart Hélène , Douillard Jean-Yves , Bennouna Jaafar , Darmaun Dominique 
Published: February 2017

213 Background: The objective of this retrospective study was to assess the impact of malnutrition in patients treated in 2012 at the Integrated Center for Oncology René Gauducheau (Nantes, France) by palliative platinium based chemotherapy and pemetrexed for a lung adenocarcinoma. We studied toxicities of chemotherapy, overall survival of patients, nutritional support and outcome of the patients. Methods: We determined for these patients if they were malnourished or well-nourished at diagnosis (as defined by a weight loss > 5% in 1 month or > 10% in 6 months, or a body mass index ≤ 18.5 under 70 years old or < 21 after 70 years old, or hypoalbuminemia < 30 g/L under 70 years old or < 35 g/L after 70 years old). Results: Among the 48 patients eligible for study, 15 were not included because it was impossible to determine if they were malnourished or not; 14 patients were malnourished at diagnosis and 19 patients were well-nourished. Other than in cases of anorexia, malnourished patients didn’t experience more adverse effects of chemotherapy. Treatment response was equal in the two groups. The median overall survival was shorter for malnourished patients than for well-nourished patients (8 vs 23 months, p=0,0089, HR 3,747 ; 95% CI : 1,443 – 9,732). Nutritional support was given most frequently to malnourished patients than to well-nourished patients (64,3% vs 21,1%, p=0,0286) and care consisted of counseling for 7,1% of malnourished patients and 10,5% of well-nourished patients and oral supplements for 50% and 10,5% respectively. Enteral feeding was given to one malnourished patient and another one refused it. None received parenteral nutrition. At relapse, well-nourished patients received more lines of chemotherapy than malnourished patients (p=0,0377). Conclusions: Our results suggest that malnourished patients upon diagnosis don’t suffer more side effects from chemotherapy than well-nourished patients. Yet they have poorer overall survival and received less other lines of chemotherapy at relapse. Early nutritional care integrated to support care is required for patients with metastatic lung cancer.
Quality of life and adverse drug reaction measured in patients undergoing cancer chemotherapy.
Authors: Singh Harminder , Banipal Raja , Bala Ritu 
Published: February 2017

214 Background: Cancer prevalence in India is estimated around 2.0-2.5 million, 0.7- 0.8 million new cases identified every year, and cancer deaths reported per year is 0.4-0.5 Million. The objective of this study was to analyze and compare patient-reported QoL (quality of life), and their physical/psychosocial symptom and adverse drug reaction in cancer patients. Methods: Study done by questionnaire EORTC QLQ-C30. Comparison among 3 distinctive groups (G) (varied number of Chemotherapy cycles) was done. ADR measured appropriately Results: 131 patients were recruited and QoL scoring GHS (global health status) and 4 items of symptom scale i.e. insomnia, pain, appetite loss, constipation, and financial difficulties attained a significance difference. GHS significantly improved in G3 as compared to G1, indicating that the patient overall health improved as the chemotherapy sessions progressed. Female patients had more ADR (mean 3.2/person) and G3 had more ADR (mean 3.96). Conclusions: QoL score didn’t show significant improvement in all areas (except insomnia, pain, appetite loss, constipation & financial difficulties), a judicious diagnosis with an appropriate treatment including chemotherapy may lessen the negative perception of cancer. [Table: see text]