bluuebunny/crossref_metadata_2025_split huggingface dataset:
Good usage of epoetin alpha biosimilar: A subanalysis of the orheo study.
Authors: Michallet Mauricette , Soubeyran Pierre , Luporsi Elisabeth , Kurtz Jean-Emmanuel , Albrand Helene 
Published: February 2017

217 Background: Chemotherapy-induced anaemia (CIA) is a frequent complication of patients with cancer. The ORHEO (place of biOsimilaRs in the therapeutic management of anaemia secondary to chemotherapy in HaEmatology and Oncology) study was a post-marketing, observational, multicentre study conducted in France that evaluated the changes in haemoglobin (Hb) level in patients with solid tumours, lymphoma or myeloma, treated with an epoetin alfa biosimilar (EAB) (Retacrit, Hospira Inc.). In this subanalysis of the ORHEO study, we compare the usage of EAB in relation to the dosage recommendations of the European Organisation for Research and Treatment of Cancer (EORTC) guidelines, regarding two criteria: efficacy and safety profile. Methods: Patients with CIA receiving chemotherapy for solid tumours (breast, lung, colorectal), lymphoma or myeloma, and prescribed EAB were monitored at the start of the EAB therapy (D0), at 3 months (M3) and 6 months (M6). Hb response was defined as achievement of target Hb without blood transfusions in the preceding 3 weeks and during treatment or Hb ≥10 g/dL orHb increase ≥1 g/dL since inclusion. The prescribed dosage of EAB according to body weight and the tolerability of EAB at that recommended dosage were analysed at each time point. Results: Data from 2310 patients were analysed. Throughout the study 43.8% of patients received the recommended dose of EAB as determined by their weight. Overall, the percentage of responders was 81.6% at M3 and 86.5% at M6. Responses to treatment (meeting predefined Hb target levels) at M6 were similar whether or not EAB was prescribed at the recommended dose throughout the study. A similar proportion of patients receiving the recommended dose of EAB reported adverse events (AEs) at M6 compared with patients who did not receive the recommended dose (9.9% vs 9.0%). Overall, the incidence of thromboembolic events was 3.5% over the duration of the study (M3 2.4%; M6 1.5%). Conclusions: Of the 2310 patients with CIA included in this analysis, less than half (43.8%) received the recommended dose of EAB over the six-month course of the study. The majority of patients had a similar response to therapy regardless of dose. The frequency of overall AEs at M6 did not vary depending on dose. Clinical trial information: NCT02140736.
Derivation and validation of a risk model for emergency department palliative care needs assessment using the Screen for Palliative and End-of-Life Care Needs in the Emergency Department (SPEED).
Authors: Moulia Danielle , Binney Zachary O. , Quest Tammie E. , DeSandre Paul , Vanairsdale Sharon , Janssens A. Cecile 
Published: February 2017

22 Background: A key setting for the provision of palliative care is the emergency department (ED) where important decisions regarding treatment and next site of care are determined; however identifying patients who would benefit from a palliative care consult is an ongoing challenge. The (SPEED) is a 5-question tool that assesses unmet palliative care needs. Methods: We performed a retrospective derivation and temporal validation of a risk model for a palliative care event (PCE) among cancer patients with an ED visit and subsequent hospital admission using data available upon arrival, including data from the SPEED tool. A PCE was defined as a palliative care consult, discharge to hospice, or in-hospital death. We developed a multivariate logistic regression model to predict PCEs. We assessed model performance using a receiver operating characteristic curve and visual inspection of quintile plots. Results: Eleven factors were identified as predictive of a PCE, including SPEED score, proxy SPEED informer, age, EMS arrival, emergent or immediate ED acuity, the number of ED visits within the last 90 days, metastatic cancer, cardiac arrhythmias, coagulopathy, depression and weight loss. In validation, the risk model had an area under the curve of 0.72 and calibration showed an underestimation of risk in the second and third quintiles. Conclusions: A risk model based on SPEED score has been successfully derived, but needs a larger dataset for proper validation. If the predictive ability of the model is confirmed, a risk model can efficiently identify cancer patients arriving to the ED who may benefit from early initiation of a palliative care consult.
Relationships among patients’ ability to identify their cancer stage, knowledge of care options, and management of transitions.
Authors: Hinchey Jenna , Goldberg Jessica , Linsky Sarah , Linsky Rebecca , Jeon Sangchoon , Schulman-Green Dena 
Published: February 2017

224 Background: Discrepancies may exist between what oncologists communicate and what patients understand about their cancer stage. We explored women’s ability to correctly identify their stage of breast cancer among a sample of women recently diagnosed with nonmetastatic (Stage I-III) disease. Methods: As part of a cancer self-management study, we asked women with non-metastatic breast cancer to identify their stage of disease. Participants’ responses were compared to their electronic medical record (EMR) for validation. We calculated descriptive statistics and used logistic regression to examine relationships between knowledge of stage, demographic and clinical variables, and study outcomes (Control Preferences Scale- CPS, Knowledge of Care Options Test- KOCO, Measurement of Transitions Scale- MOT, Medical Communication Competence Scale- MCCS, Chronic Disease Self-Efficacy Scale- CDSE, Uncertainty in Illness Scale- MUIS-C, and Hospital Anxiety and Depression Scale- HADS). Results: Participants (n= 100) had a mean age of 52.3 years (range 27-72). Per the EMR, 19 participants (19%) had Stage I breast cancer, 57 (57%) had Stage II, and 24 (24%) had Stage III. Twenty-nine participants (29%) were unable to correctly identify their stage of cancer. Of this group, 11 (39.3%) provided vague responses, 11 (39.3%) reported an incorrect stage, and 7 (25%) did not know/want to know their stage. Younger age (p=.0412) and earlier cancer stage (p=.0136) were predictive of correctly identifying cancer stage. Participants who at baseline had a greater knowledge of care options were more likely to correctly identify their cancer stage (KOCO, p=.0482). Those who correctly identified their cancer stage were better able to manage transitions over time (MOT, p=.0564) than those unable to identify their stage. Conclusions: Women who cannot correctly identify their cancer stage may neither understand its implications nor effectively participate in cancer self-management. Conversations about cancer stage should be revisited to ensure patients’ understanding. Future research should include women with Stage IV breast cancer to more completely investigate ability to identify cancer stage.
Cancer patients’ awareness and role in family-based medical decision-making mode in Confucian area.
Authors: Li Xing , Dong Min , Wen Jing-yun , Wei Li , Ma Xiao-kun , Xing Yan-Fang , Wu Xiang-yuan , Lin Qu 
Published: February 2017

227 Background: Medical decision making of Chinese patients was family based, which was criticized for the latent moral risk. However, few studies have systematically illustrated the risks of the mode. We aimed to illustrate the determinant of patients’ role in decision making. Methods: A total of 644 adult cancer patients were included in this study between September 1, 2013 and December 31, 2013 from 13 leading general hospitals across China. A questionnaire was give to the oncologists in charge to evaluate each patient concerning the interaction between family and cancer patients, patients’ awareness of disease and participation in medical decision making in mainland China. In this study, the family statuses of patients were ranked as superordinate (one who was the major decision maker in family), equality (one discussed important issues with family members), and subordinate (those who usually don’t be involved in significant family issues). Results: Among the 644 cancer patients, only 125 (19.4%) patients made decision themselves. 291 (45.2%) patients delegated decision making to their family. The rest of 228 (35.4%) patients were involved in decision making. Patients with nonlocal insurance, which meant they traveled to the major cities for advanced medication, were inclined to let their family members make decision for them. Patients’ family status significantly determined their participation in medical decision making. Patients, as superordinate family members, tend to play a positive role in medical decision. By contrast, patients with subordinate role in family continued to play a passive role in medical decision making. Violation of medical recommendation increased according to the severity of patients’ prognosis. The reasons of violation were mainly financial problems. Distrust to doctors presented in merely about 5% of the cases. And conflicts between family members were extremely scarce. Bad news was always hidden from patients, especially for those with incurable disease. Conclusions: Medical decision making of Chinese cancer patients was family based. Patients’ awareness of disease and participation in medical decision making relied on their family status and family financial situation.
Feasibility of prophylactic haloperidol to prevent delirium in cancer patients.
Authors: Weckmann Michelle , Nguyen Christopher 
Published: February 2017

232 Background: Approximately 2.5 million cancer patients are hospitalized annually and 25-40% of them will suffer from delirium; yet the majority of delirium is not diagnosed or treated. Delirium rates vary by age and reason for hospitalization and can be as high as 70% in hematopoietic stem cell transplant (HSCT) patients post-transplantation. Delirium can have devastating short and long-term complications and research is ongoing to see if it can be prevented. This study aims to: 1) demonstrate the feasibility of using prophylactic haloperidol in HSCT patients; 2) determine the side effects of oral haloperidol in HSCT patients; and 3) explore the hypothesis that prophylactic haloperidol will reduce the rate of delirium following HCST. Methods: All cognitively intact HSCT patients at a large academic institution were approached for study inclusion. Patients with delirium at time of screening or antipsychotic use in the previous 30 days were excluded. All participants received 5 mg oral haloperidol the night prior to transplant and nightly for 2 weeks post-transplant. Participants were seen daily to evaluate for side effects and every other day to evaluate for delirium using the Delirium Rating Scale (DRS-98). Results: Of the 19 patients who enrolled: 5 withdrew; 9 completed the full (2 week) study; and 5 completed a portion of the study. 22% (2 of 9) patients developed delirium (compared to a historical rate of 43% on our unit). Haloperidol was well tolerated with no evidence of major side effects (1 report of mild restlessness and 1 patient had transient evidence of sedation). Conclusions: Oral haloperidol was well tolerated in HSCT patients. While this study was not designed to detect differences in delirium incidence it provides promising evidence that prophylactic haloperidol may decrease delirium post-HSCT.
Pilot feasibility study: Eliciting provider and patient perspectives to help African American families cope with parental cancer.
Authors: Young Faith , Davey Maureen 
Published: February 2017

233 Background: 1.2 million African American (AA) parents/guardians of school age children may be diagnosed with cancer in 2014. AAs have a disproportionate burden and mortality from solid tumor cancers. However, AAs are poorly represented in distress intervention studies, and psychosocial oncology support services may not be designed for culturally diverse populations. The goal of this pilot study was to gather feasibility data from a sample of AA medical providers and from a sample of 100 cancer patients. This approach aided development of effective structures and procedures to recruit AA cancer patients/guardians raising school-age children for a culturally sensitive family intervention program. Methods: We developed a focus group guide for AA medical providers to define best practices for recruiting AA cancer patients into an intervention program. The focus group of AA providers (4 oncologists, 3 primary care, and 3 family practitioners) first reviewed the treatment manual for cultural content. We then conducted an anonymous patient needs assessment, broadly sampling cancer patients from outpatient and inpatient settings (n=100). Results: Providers and patients identified transportation support, refreshments, and onsite care for young children as important. Both groups recommended targeting AA parents/guardians within the first months of diagnosis, when coping with a cancer diagnosis is acute. Parents/guardians who had current concerns about their children more often reported an interest in family support, and patients felt that a location other than the cancer center would be most comfortable for their children. Conclusions: Effective treatments to help children and adolescents cope with the impact of parental cancer are critical, particularly those targeting low-income AA populations. The provider focus group and patient needs assessment identified recruitment barriers in anticipation of a randomized control trial designed to address family distress after parental cancer diagnosis. This approach has the potential to impact the nature of treatment support options available to a group that is overrepresented and underserved by existing interventions.
Receiving a cancer diagnosis: Interview of random and not ill population.
Authors: De Paula Bruno Henrique Rala , Millen Eduardo Camargo , Almeida Rodrigo , Almeida Fernando C. O. 
Published: February 2017

235 Background: In clinical practice the way you communicate a diagnosis is very important, especially because the reaction of patients is unexpected. Studies performed in order to check for trends or predictors that news produces no harmful effects and possibly to generate further patient adherence. However studies are focused on evaluate sick patients or their family members, referring to the need to evaluate a random population which is the distribution of opinions as the patient arrives at the doctor's office. Methods: Were interviewed 1,191 people randomly by medical students, on the streets of Volta Redonda city, RJ, between January and December 2010 after the exclusion criteria were tabulated 1,181 questionnaires. Results: 8.13% of responders would not like to be told that they had cancer. 27.51% believe that there is a reason not to tell the patient the diagnosis, and the reasons were: 40% psychological effects ; very committed clinical status 18.46%, embarrassment or discrimination 12.92%; mercy 9.23% and other opinions 19.38%. Cases of cancer in family were 48.01% and 74.11% of those the patient was not informed and the relative judged important the patient knowledge about their condition. Predominance of the way we should tell the patient his diagnosis according to the responders was 41.06% (patient, family and doctor in a moment), 29.46% (only doctor and patient) and 24.80% (the family knowing the diagnosis informing your loved sick in a second time). When asked if they should start cancer treatment before telling the patient to 8.89% of respondents said yes. And 68.57% of people believe to be beneficial to start treatment before telling the patient his diagnosis, said they think their next of kin should be informed that he has cancer. Conclusions: Receiving a cancer diagnosis is not easy for some individuals. Depending on who has cancer, person or a relative, some individuals are more likely to dissent opinion on whether to inform or not the diagnosis. There was a tendency to prefer the diagnosis is communicated by the doctor to the patient with family present. Finally there might be a correlation between the respondents believe that it is important to start treatment before giving the diagnosis to a relative.
An algorithm to identify delivery of palliative radiation therapy using health care claims data: A proof of concept application of data visualization tools in the prostate cancer (PCa) setting.
Authors: Onukwugha Ebere , Gardner James F. , Jayasekera Jinani , Malik Sana , Hussain Arif , Mullins C. Daniel , Valderrama Adriana , Seal Brian S. , Kwok Young 
Published: February 2017

248 Background: Studies using healthcare claims data to investigate the burden of skeletal-related events employ various approaches to identify radiation to the bone (RttB) because billing codes available in claims data do not distinguish RttB from radiation to the prostate gland. We investigated the use of Eventflow data visualization software to identify components of a claims-based algorithm for RttB. Methods: We analyzed data for PCa cases identified in the Surveillance, Epidemiology, and End Results (SEER) registry data linked with Medicare claims. We identified two cohorts of individuals diagnosed between 2005 and 2009 and receiving radiation therapy, C1: diagnosed with incident bone metastasis (BM) according to SEER data; C2: diagnosed with incident stage IV M0 PCa. We defined radiation episodes of care from claims for external beam radiation therapy, radiopharmaceutical therapy, intensity modulated radiotherapy and stereotactic radiosurgery. Eventflow was used to compare cohorts and identify criteria for identifying RttB using claims data. Results: Application of inclusion criteria resulted in 1,491 individuals: 999 in C1 and 492 in C2. Median follow up was 596 days in C1 and 882 days in C2. Average age was 77 years in C1 and 73 years in C2. The median time to radiation therapy was 133 days in C1 compared to 171 days in C2. When requiring a BM diagnosis code on the radiation claim, the median time was 160 days in C1 compared to 514 days in C2. The median time to a fracture was 107 days in C1 compared to 369 days in C2. The median time to bone surgery was 183 days in C1 compared to 447 days in C2. The median time to spinal cord compression was 154 days in C1 compared to 375 days in C2. A BM diagnosis code concurrent with the radiation episode and radiation episodes less than or equal to 4 weeks in length were more common among C1 compared to C2. Conclusions: Analysis of data visualization output indicates that incorporating a bone metastasis code on claims concurrent with a radiation episode of care or the information regarding the length of the radiation episode will be useful for identifying receipt of palliative radiation using claims data.
A systematic and interdisciplinary approach to the measurement of outcomes over the disease trajectory in a unique specialized cachexia clinic.
Authors: di Tomasso Jonathan , Ciutto Lorella , Cesare Sabrina , Uscatescu Irina , Yu-Chueh Kevin , Olders Henry , Aubin Nathalie , Kelly Mary Lou , Jelowicki Marta , Laroui Rabiaa , O'Grady Rosemary , Borod Manuel , Kilgour Robert , Vigano Antonio Angelo Luciano 
Published: February 2017

25 Background: Cancer cachexia affects 60-80% of advanced cancer patients and leads to weight loss, worsening functional status, and increased mortality. Thus, specialized clinics are needed to measure nutritional and functional trajectories over time in this population. Recently, the McGill University Health Centre has developed a systematic, standardized and interdisciplinary approach for the profiling and management of cancer cachexia. Methods: Patients with advanced cancer were recruited and categorized as cachetic. The following information was collected at baseline and at three follow-up visits: hand grip strength measured by Jamar dynamometer, the Edmonton Symptom Assessment System (ESAS) and the abridged Patient Generated Subjective Global Assessment (aPG-SGA) questionnaires. Results: Fifty-nine patients were eligible for this study yet only 24 completed 3 follow-ups and were included. There were 15 men and 9 women, mean age 65.7 years. Five patients had locally advanced disease and 19 had metastatic disease. The table contains results for handgrip strength, ESAS and aPG-SGA scores. Conclusions: Following baseline assessment and treatment, patients were noted to have a significant improvement in the aPG-SGA total score. Handgrip strength was maintained throughout the follow up period. ESAS appetite and fatigue exhibited a positive trend but did not achieve significance over time. This work suggests the benefits of an interdisciplinary cachexia clinic for the maintenance of nutritional and functional status in patients with cancer cachexia as well as possible improvements in quality of life. [Table: see text]
Early palliative care on an inpatient oncology unit: Impact of a novel co-rounding partnership on patient and health system outcomes.
Authors: Riedel Richard F. , Slusser Kim , Power Steve , Jones Christopher A. , LeBlanc Thomas William , Kamal Arif , Desai Devi , Allen Deborah , Galanos Anthony N 
Published: February 2017

3 Background: Early palliative care (PC) improves outcomes for outpatients with advanced cancer, but its impact on an inpatient oncology unit is unknown. We implemented a novel inpatient medical oncology (ONC) and PC co-rounding partnership on September 1, 2011 at Duke University Hospital. Here we report its impact on patient and health system outcomes during its first year of implementation. Methods: We extracted patient data including demographics, cancer diagnosis, disease status, length of stay (LOS), ICU transfer rate, discharge disposition, time to ER return, time to readmission, and 7- and 30-day ER return and readmission rates (RR). Pre- and post-intervention cohorts were defined as all patients admitted or transferred to the solid tumor inpatient service from September 1, 2009-June 30, 2010 and September 1, 2011-June 30, 2012, respectively. Nursing and physician surveys assessed satisfaction. We used descriptive statistics, Student’s t-test, and Fisher’s exact test for analyses. Results: The pre- and post-intervention analysis cohorts included 731 and 783 patients respectively, representing 2,353 encounters. Cohorts were similar in baseline characteristics, including mean age (61 vs. 62; p=0.07), gender (male: 51% vs. 48%; p=0.22), race (white: 68% vs. 71%; p=0.39), insurance coverage (Medicare: 49% vs. 51%; p=0.96), and disease status (recurrent/metastatic: 73% vs. 74%; p=0.6). Post-intervention patients had a statistically significant decrease in mean LOS (p=0.02) from 4.51 days (95% CI 4.3-4.73) to 4.17 days (95% CI 3.97-4.37), and statistically significant improvements in 7- and 30-day readmission rates, representing a 15% (p=0.03) and 23% (p=0.05) improvement, respectively. We observed a trend for increasing hospice referral (p=0.09) and a 15% decrease in ICU transfers. Physicians and nurses universally favored the model. Conclusions: A fully-integrated, inpatient co-rounding partnership between PC and ONC resulted in statistically significant improvements in key health system-related outcomes and indicators of quality cancer care.