bluuebunny/crossref_metadata_2025_split huggingface dataset:
Toxicity of sequential immune therapy and radiation for cervical and thoracic spine metastases.
Authors: Arscott W. Tristram , Doucette Abigail , Kumar Pallavi , Plastaras John Peter , Maity Amit , Jones Joshua Adam 
Published: November 2017

130 Background: Palliative radiation is an effective treatment modality for spinal metastases. Expanding use of immune therapy in metastatic cancer raises concern that side effects from treatment may be exaggerated, particularly to sensitive organs such as the esophagus. This retrospective review evaluates the toxicity of combined radiation and immune therapy in patients with cervical or thoracic spine metastases. Methods: Patients receiving radiation for cervical or thoracic spine metastases from 2012-2017 were selected based on (1) concurrent use of immune therapy and radiation (within 7 days) OR radiation within 30 days following immune therapy, (2) 3D conformal or simpler treatment technique, and (3) minimum 30 days follow up from end of treatment. Patient demographics, radiation treatment parameters, immune therapy agent(s), and maximum toxicity were extracted from the medical record. Isoeffective dose was calculated using the EQD2 model, assuming α/β of 3. Statistical analyses included t tests. Results: Twenty-two patients were identified. Pembrolizumab was most commonly combined with radiation (8 patients), followed by nivolumab (7), ipilimumab (3), and atezoliumab (2). Two patients received both nivolumab and ipilimumab. Three patients (14%) had grade 3 toxicity requiring hospitalization (vomiting, esophagitis), 8 patients (36%) had grade 2 toxicity (esophagitis, dysphagia), 3 patients (14%) had grade 1 toxicity (hoarseness, dysphagia), 8 patients (36%) had no toxicity. Two patients (67%) with grade 3 toxicity received concurrent nivolumab and ipilimumab. Median dose was 3600 cGy (EQD2) in 10 fractions. There was a trend to greater toxicity with increased number of vertebral levels treated (mean 3.4, 4.6, 5.625 and 6.3 for toxicity grade 0, 1, 2 and 3, respectively; p= 0.053). Dose, fractionation, and immune therapy agent were not found to be significant contributors. Conclusions: In this small cohort, combined immune therapy and radiation for palliation of cervical or thoracic spine metastases suggests increased toxicity when greater number of vertebral bodies are irradiated or when combined immune therapy agents are utilized. Further investigation with a larger cohort is warranted.
A three step process to create a palliative medicine co-management model of care on an inpatient hematology unit.
Authors: Decastro Gene , Earle Bridget 
Published: November 2017

141 Background: Northwell Health’s North Shore University Hospital (NSUH) campus has a dedicated hematology unit. This cohort of patients is under-represented on our inpatient palliative care service, comprising < 1% of initial consultations in 2016. Given recent recommendations by the American Society of Clinical Oncology about comprehensive cancer care, and recognizing the growing need for palliative care for patients with hematological malignancies, our goal was to initiate a concurrent hematologic and palliative care delivery model. Methods: A three step process was initiated – inpatient service buy-in and joint workgroup development, concurrent care delivery, and linkage to outpatient partners. The first step was to obtain buy-in with faculty stakeholders at our institution, including Hematology-Oncology leadership. There was immediate support for a partnership. Next, a workgroup was assembled to jointly generate a needs assessment survey to determine how best to assist in the care of these complex patients. Additionally, we identified key metrics to measure, and linked our inpatient service with outpatient care via our Supportive Oncology practice. Results: The five month process culminated in biweekly “screening rounds” with the Hematology team which were initiated in June 2017 and used as a first step to identify high-need patients for consultation. The workgroup agreed upon performance metrics which included hematologic diagnosis, reason for consult, time to consult from admission, length of stay, documentation of advance directives and goals of care, and outpatient referrals. Conclusions: Through relationship management, workgroup development, and care transition to community, an inpatient supportive care co-management model for patients with hematologic malignancies was successfully implemented using a three-step process. This format and strategy can be replicated for other services with complex patients. Future analysis of the outcome metrics will be able to provide feedback to the Palliative – Hematology services. By creating health care pathways with an emphasis on Palliative Medicine co-management, we are poised to deliver comprehensive care and measure its impact.
Using a framework for resource stratification to adapt palliative care guidelines to Sub-Saharan Africa.
Authors: Dans Maria Cristina , Abdella Kunuz , Baah-Odoom Dinah , Kintu Rinty , Kolawole Israel , Manirakiza Sebastien , Munyoro Esther , Obrien Megan , Carlson Robert W. 
Published: November 2017

145 Background: The National Comprehensive Cancer Network (NCCN) is a not-for-profit alliance of 27 leading cancer centers in the United States (US), but the NCCN’s mission to improve cancer care extends world-wide. Nearly half of the registered users of the NCCN Guidelines are based outside the US, and the NCCN has developed a process for adapting its Guidelines to lower-resourced settings. The cancer burden in Sub-Saharan Africa (SSA) is significant – by 2030, annual cancer deaths in the region are projected to reach 1,000,000 people – and most cancers diagnosed in SSA are late-stage. Methods: The NCCN Framework outlines a rational approach for constructing cancer management systems to provide the highest achievable care. Each of the 4 NCCN Framework levels builds on the one before it, so care can evolve as resources grow: “Basic Resources” are essential for care; “Core Resources” add services improving disease outcomes; and “Enhanced Resources” include more cost-prohibitive services. The Guidelines themselves are the final level: evidence-based, consensus-driven recommendations from each NCCN Panel. Resource-stratification begins with modification of the Guidelines by a NCCN Framework Committee within each Panel. Results: In the case of SSA, organizers from the NCCN, American Cancer Society, Clinton Health Access Initiative, and IBM arranged 3 consensus meetings in which resource-stratified drafts of the Guidelines for Palliative Care and Cancer Pain will be refined by a committee of NCCN representatives, oncologists, and palliative care providers from Burundi, Ethiopia, Ghana, Kenya, Nigeria, Uganda, and the US. Important themes emerging from the first meeting included early screening for palliative care needs, even before tissue diagnosis, in areas with limited availability of anti-cancer therapy. In addition, cultural differences on the topic of “Physician-Aid-in-Dying” led to its replacement with guidance on caring for patients expressing a wish to die. Conclusions: Collaboration with colleagues in SSA, and other areas around the globe, to resource-stratify NCCN Guidelines will allow more systematic use of the guidelines and improve the quality, effectiveness, and efficiency of cancer care.
Call to integrate supportive care and patient reported outcomes in early phase clinical trials: An exploration of adolescent and young adult (AYA) participation on phase I trials of novel anticancer agents.
Authors: Subbiah Ishwaria Mohan , Tang Chad , Rao Arvind , Subbiah Vivek , Kurzrock Razelle , Hong David S. 
Published: November 2017

149 Background: Adolescent and young adults (AYA) aged 15-39 years with cancer represent a patient population with very unique needs extending into the psychosocial realm. Consequently AYA participation on cancer clinical trials has been dismally low in recent decades, particularly on early phase trials with investigational agents. In an effort to better understand AYAs with advanced cancer, we analyzed their characteristics and participation on phase I clinical trials. Methods: We queried a department database to identify 1489 consecutive pts treated on phase I trials bw Dec 2004-July 2013 and then divided into 2 age-based groups (AYA 15-39y, mid age 40-64y) for analysis of their baseline characteristics, participation, time to treatment failure (TTF), and imaging response. We then calculated the odds ratios of achieving a favorable clinical benefit (defined as a RECIST response of prolonged SD≥6m+PR+CR) for AYAs vs mid-age pts. Results: AYAs represented 15% (n = 220) of participants treated on phase I trials while 67% (n = 991) were middle age. Most AYAs were women (63% female, 33% male) w median age being 32.6 years and a median of 3 prior therapies. AYAs most commonly had GYN (n = 41, 19%), sarcoma (n = 39, 18%), GI (n = 35, 16%), thoracic/head/neck (n = 31, 14%), melanoma (n = 27, 12%), and breast (n = 20, 9%) cancers. AYA had a comparable median TTF of 3.3m to mid age pts (3.5m). Overall, 369 (37%) mid age and 96 (44%) AYAs received a non-FDA approved agent. Imaging responses among AYAs showed 93 (42%) SD including 42 (19%) prolonged SD (median duration 9.7m), 34 (15%) PR (median duration 9.5m), and 2 AYAs with a CR lasting 36.2m and 50.1m. Conclusions: AYA patients represented just 15% of phase I clinical trials participants; none of these trials measured patient reported outcomes or quality of life indices, highlighting an urgent need for comprehensive supportive care integration into AYA care to tend to the unique psychosocial, economic, and family needs of this population to ultimately identify and overcome barriers to clinical trial participation.
Living goals: Prepare to die.
Authors: Mehta Zankhana , Smith Susan , Henrichs Jane , Berger Andrea , Comstock Loreen , Davis Mellar 
Published: November 2017

157 Background: Living Goals (LGs), a home-based program, is a collaboration between Geisinger Health Plan, Geisinger Home care and Hospice and Palliative Medicine. Program investigated an early intervention in those with serious illness and transition to hospice in a timely manner during FY 2015- 2017. Methods: LGs visits were led by a registered nurse after referral from physicians based on the surprise question (it would not be a surprise if this patient died within one year). Nurse facilitated end-of-life discussions and provided resources available for supportive care. LGs visits were free up to 10 visits to each patient. Results: 94 patients were enrolled in LGs from 128 referrals.59 (63%) patients transitioned to hospice and 41 (69%) were transitioned within first month of LGs visit averaging 1.4 visits. 59 patients enrolled in hospice. The median length of time between LG Start of care (SOC) and Hospice SOC is 9 days (IQR: 3-73).57 LGs patients discharged from hospice had a median length of stay (LOS) of 39 days (IQR: 10-85). For the subset of patients in FY 2015 (n = 13) median LOS was 26 days (IQR: 10-57)), in FY 2016 (n = 26) the median LOS was 27 days (IQR: 7-73), in FY 2017 (n = 18) the median LOS is 66 days (IQR: 28-144). In FY 2014, 513 hospice patients were discharged before initiation of LGs and the median LOS was 19 days (IQR: 6-61). As of now, there is a significantly longer stay for LG patients than FY 2014 hospice patients (p = 0.0130). Conclusions: This innovative home based program, appears to have a great potential in the future for delivering ongoing hospice and palliative needs to seriously ill patients.
Outcomes of an innovative six-week standardized residential training course for physicians and nurses to provide primary palliative care in India.
Authors: Reddy Suresh , Vallath Nandini , Gupta Mona , Gujela Manoj , Mohan Sarath , Naik Navami , Yennu Sriram , Bruera Eduardo , Rajagopal M.R 
Published: November 2017

160 Background: The National Program on Palliative Care (NPPC) by the Government of India has emphasized the need for training clinicians in providing palliative care (PC) with minimum of 6 weeks of residential training. However, there are limited studies on feasibility of such standardized training in PC offered to palliative care providers interested in transition to palliative care. Aim: To evaluate the feasibility, and change in the self-reported perception of knowledge in palliative care following a 6 weeks standardized residential training course (SRTC) for physicians and nurses to provide primary PC in India. Methods: A 6 week standardized residential type educational program which combined didactics, and bedside hands on palliative care training by PC specialists in five preselected centers in India. To be eligible licensed physicians and nurses should, (a) qualify in focused interview aimed to evaluate both interest and commitment to provide primary palliative care following the training, (b) Agree to complete all the required surveys. Results: 46/53 (86%) completed the pre and post surveys. 50/53 (94%) participants completed the course and passed the certification exam. Median age (IQR) was 31 (27, 41). 53% were female and 53% were physicians. Median reported knowledge (1-5) for pain, fatigue, delirium, medical ethics were 4,3,2,2.5 before training Vs 5 (P=0.001), 5 (P=0.001), 5 (P=0.001), 5 (P=0.001) after training respectively. All other core areas improved significantly. All participants noted satisfaction with faculty as high (5/5). Conclusions: Conducting a six weeks standardized residential training course in PC for physicians and nurses in India is feasible. There was a significant improvement in self-reported knowledge of all components of palliative care curriculum. Long term impact studies are needed.
First referral to an integrated onco-palliative care program: A retrospective analysis of its timing.
Authors: Barth Claire , Colombet Isabelle , Vinant Pascale 
Published: November 2017

167 Background: Despite being recommended early in the course of advanced cancer, palliative care (PC) referral remains often late. Taking into account limited PC resources, disease-specific referral criteria and models of care need to be explored. In a previous work, we showed that a weekly onco-palliative meeting (OPM) allowed earlier introduction of the PC team (PCT) and decreased aggressiveness of end-of-life (EOL) care1. We describe patient’s profile when first referred to this Integrated Onco-Palliative Care program (IOPC), the timing of the referral relatively to the course of his/her disease and the impact on the trajectory of EOL care. Methods: The IOPC of our University Hospital combined a weekly OPM, dedicated to patients with incurable diseases for whom goals and organization of care need to be discussed, and/or clinical evaluation with possible follow-up by the PCT. We retrospectively analysed all patients reported for the first time at OPM between 2011 and 2013. We calculated an index of precocity, defined as the ratio of time from the first referral to death and the time from the diagnosis of incurability to death, with values ranging from 0 (late referral) to 1 (early referral). Results: Of the 416 patients included, 57% presented with lung cancer, urinary carcinoma and sarcoma. At first referral to IOPC program, 76% were receiving chemotherapy, 63% were outpatients, 56% had a PS ≤ 2 and 46% had a serum albumin level > 35g/l. The median (1st-3rd quartile) index of precocity was 0.39 (0.16-0.72), ranging between 0.53 (0.20-0.79) (earliest, for lung cancer) to 0.16 (0.07-0.56) (latest, for prostate cancer). Among 367 decedents, 42 (13%) received chemotherapy within 14 days before death, 157 (43%) died in hospice care setting. Conclusions: Most patients first referred to IOPC were still under antitumoral treatment and had intermediate prognostic markers. However the time of referral between diagnosis of incurability and death is highly variable according to cancer type, and should probably be adapted while therapies progress.1 Colombet I, et al. Effect of integrated palliative care on the quality of end-of-life care: retrospective analysis of 521 cancer patients. BMJ Support Palliat Care. 2012;2(3):239–47
Supportive care day hospital: A new tool for palliative care in cancer centers.
Authors: Bouleuc Carole 
Published: November 2017

170 Background: In May 2005, the Curie Institute in Paris opened the first supportive care day hospital in France. This type of new ward is now very frequent in the French comprehensive cancer centers. Methods: Patients are managed by the palliative care team with a two-part team of a physician and a nurse in order to address their supportive care needs: advanced-care symptoms, psychosocial distress, medical questions and concerns, support need in decision making, end of life care preference and advance care plan when patients or caregivers when needed. Depending of the needs identified by the palliative care team assess, at least 2 of the following healthcare professionals will intervene: oncologist, pain physician, psycho-oncologist, dietitician, social worker, physiotherapist. Coordination with the home care team takes systematically place (with general practitioner, nurse and home palliative care team). New symptoms occurrence are explored with biological test or radiographic examination when necessary. Medical procedures are sometimes performed like venous perfusion therapy, blood transfusions, or draining effusion after ultrasonic tracking. It is possible to offer the patient hypnosis, relaxation or sophrology consultation. Eventually at the end of the in-patient stay, the patient is given a medical synthesis with therapeutic recommendations and personalized care plan. 1 Physician and two nurses are needed to manage 4 patients every day. Results: In 2016 we have admitted 350 patients and performed 948 stays in our supportive rand 55% of them have breast cancer. Median survival since the first day at supportive care day hospital is 65 days. Death at home occurred in 15% of patients and in hospice for 62%. Home death is more often when patients don’t have any dyspnea are included in a home palliative care network and when they receive the last chemotherapy more than 30 days before death. More date will be shown. Conclusions: Supportive care day hospital is really a good tool for integrated palliative care, promoting collaboration with oncologists, coordination with home care teams, and advance care planning, so that patients can longer stay at home as they often hope so.
Outcomes of a Dignity Therapy/Life Plan intervention for advanced cancer patients undergoing treatment.
Authors: Dose Ann Marie , McCabe Pamela J , Sloan Jeff A. 
Published: November 2017

177 Background: Dignity Therapy (DT) is a psychosocial intervention used primarily at the end of life to improve quality of life and promote patient dignity, but many individuals are unable to complete it due to health decline/death. In addition, when individuals face potential mortality, they evaluate life plans to determine tasks and behaviors most important to them. Consistent with guidelines to provide palliative care interventions simultaneously with cancer treatment, the purpose of this study was to evaluate initial patient-reported outcomes of an intervention combination (Dignity Therapy + Life Plan [DT/LP]) for those with advanced pancreatic or lung cancer receiving treatment within a year of diagnosis. Methods: This was a single-arm, Phase I/II pilot study, conducted in the outpatient setting at an NCI-designated comprehensive cancer center. Dignity Therapy consisted of a focused life review intervention delivered during three outpatient oncology encounters for each patient. Interviews were audiotaped, transcribed, and edited to produce a legacy document. Participants scribed a list of 3-6 life goals for the LP intervention. Outcomes measured at baseline, immediately post DT/LP, and 3 months later were distress (Distress Thermometer), quality of life (FACT and LASA), spirituality (FaCIT-Sp-12), dignity (Patient Dignity Inventory), and purpose in life (Purpose in Life Test- Short Form). Data were analyzed with one-sample, two-sided t-tests (alternate: Wilcoxan). Results: Eighteen advanced pancreatic or lung cancer patients enrolled, mean age 64. There were no significant differences among all variables from baseline to post-DT/LP and 3 months later, with the exception of less distress experienced between baseline and 3 months after DT/LP ( p= 0.04). Conclusions: The DT/LP intervention did not show improvements in these psychosocial outcomes, but patients with advanced cancer typically experience worsening physical and psychosocial symptoms with active treatment. Therefore, maintaining these outcomes from baseline is a worthy goal, as we may be preventing further morbidity in an advanced cancer population. Further research is needed, however, given this small sample size. Clinical trial information: NCT02132325.
Characteristics of patients referred for psychology services by a palliative care inpatient consult team.
Authors: Ann-Yi Sujin , Wong Angelique , Baumgartner Karen , Carmack Cindy L. , Castro Debra , Guzman Diana , Joy Manju P , Kuriakose Leela , Lim Kyu-Hyoung , Madden Kevin , Najera John M , Pangemanan Imelda , Rajani Sabeena Qasim , Raznahan Monica , Stewart Holly A , Tanco Kimberson Cochien , Tallie Kimmie , Wei Qi , Bruera Eduardo , Zhukovsky Donna S. 
Published: November 2017

183 Background: From Jan 2013 to Dec 2015, only 23% of inpatient palliative care consults were referred for psychology (PSY) services. In an effort to better understand referral practices, we compared those who were referred for PSY services to those who were not. Methods: A retrospective chart review of 930 consecutive patients from Jan 2013 to Dec 2015 was conducted to collect demographic and clinical variables. 455 patients who had at least one PSY contact and 475 patients who had no PSY contact were randomly selected. In an effort to control for age, we selected 330 patients 18-39 years, 300 patients 40-64 years, and 300 patients 65 and older. Descriptive, univariate and logistic regression analyses were conducted. Results: Patients referred to PSY services (N = 455) included 267(59%) females. Majority were White(60%) and English speaking(93%). Majority were married(62%) and parents(79%). The largest cancer type was GI(20%) followed by hematological(15%). Majority had ECOG status of 3(39%) and CAGE-AID negative (82%). Patients with no psychology consult(N = 475) included 50% females. Majority were White(60%) and English speaking(79%). Majority were married(56%) and parents(70%). This sample also had majority GI cancers(18%) followed by hematological(15%). Majority had ECOG status of 3(34%) and was CAGE-AID negative(75%). Univariate variables significant for those referred for PSY services included: Female(p = .01), English language(p = .018), ECOG score of 3(p = .006), psychiatric history(p = .008), higher MEDD(p = .001) and several ESAS subscales including depression(p = .000), anxiety(p = .000), shortness of breath(p = .017), sleep (p. = .029) and spiritual pain(p = .001). Logistic regression identified psychiatric history and ESAS depression scores as significant predictors of PSY referral. Conclusions: Several univariate factors were significantly associated with referral to PSY services. Psychiatric history and ESAS depression score showed to be strong independent predictors. These results help us to understand how palliative care providers determine those they consult for PSY services. More research is needed to investigate who may benefit most from PSY referrals.