bluuebunny/crossref_metadata_2025_split huggingface dataset:
The effect of oncology massage in the treatment and prophylaxis of patient-reported distress during cancer treatment.
Authors: Menendez Alvaro G. , Carvajal Alejandro Ramon , Cobb Regina , Healey Kathi , D'Ambra Diane , Soriano-Pisaturo Maria 
Published: February 2017

191 Background: Distress (DS) levels are usually elevated across the disease course of cancer patients. Massage Therapy (MT) can improve patient-reported DS levels. We characterize the effect of MT on DS prevention and treatment, and compare the outcomes between single and multiple treatment sessions. Methods: This was a prospective single arm intervention with pre/post assessment using the validated NCCN DS Thermometer for patients on active chemotherapy who agreed to receive at least one MT session over a 10-week period. Results: 62 pts were included. 34/62 (55%) had DS when accruement started (X = 3.82, 6±4, M = 3, SD 2.32). 33/34 (97%) had improvement of DS after 1st session regardless of the type of DS on an average of 25% (p < 0.05). From 1st MT session to beginning of 2nd MT session (5±3 wks), DS had improved in 78% (14/18) of pts on an average of 31% (p < 0.001). 4/18 (22%) reported DS worsening chronically (X = 3.5, M = 3.5). 28/28 (100%) who had no DS reported initially did not develop it by the end of their participation. Conclusions: DS is prevalent among cancer patients and can affect treatment outcomes and overall quality of life. Regardless of type and source of DS, MT resulted in relief of patient-reported DS in a cumulative manner. MT may even appear to delay or prevent the onset of DS. Further studies are needed to determine if the improvement in DS is singularly from the MT intervention the patients received or from the emotional support that the therapist provided. A randomized study is also necessary to determine frequency and total duration of optimal treatment to confirm MT’s prophylactic and therapeutic ability for DS.
Evaluation of the Japanese opioid conversion ratio for switching to methadone for cancer pain control.
Authors: Matsuda Yoshinobu , Okayama Sachiko , Yoshikawa Yoshito , Kobayashi Yoshio 
Published: February 2017

196 Background: In Japan, oral administration of methadone was approved for patients with cancer pain in March 2013. As methadone exhibits complex pharmacokinetics with individual differences and rare but serious adverse effects, methadone is only prescribed as a fourth-line drug by cancer pain specialists, who must start methadone according to the following table and must not increase methadone dose within 7 days. Aims: To assess the validity of the Japanese opioid conversion ratio. Methods: The clinical characteristics of 60 patients who were prescribed oral methadone between April 2013 and March 2016 were analyzed. Results: The switch from other opioids to methadone was initiated due to refractory pain in the stop-and-go switching. According to the table in Japan, the starting dose of methadone ranged from 15-45mg/day, depending on the previous opioid dose. Fifty cases (11 outpatients, 39 inpatients) were successfully switched to methadone; although 10 cases subsequently exhibited rapid progression of illness and failed due to oral difficulty during the course of dose titration. At the outset, the average oral morphine equivalent daily dose before methadone administration was 155mg (range, 40-660mg) and the starting methadone dose was 10 mg in 2 cases (extremely old age and multi-drug taking), 15 mg in 35 cases, 30 mg in 11 cases and 45 mg in 2 cases. Upon completion of the dose titration according to the Japanese definition, the methadone dose was the same as the starting dose in 21 cases, and was decreased or increased from the starting dose in 5 and 24 cases, respectively. Conclusions: TheJapanese opioid conversion ratio might be better corrected in the near future. For example, it is good to be able to start with 10mg or 20 mg because minute changes might lead the performance of low dose titration in some cases. It should be possible to increase the dose of methadone after 3 or 4 days from the later change based upon the pain severity. [Table: see text]
The conversion ratio from intravenous (IV) hydromorphone to oral (PO) opioids in patients with cancer.
Authors: Reddy Akhila Sunkepally , Dost Sara , Vidal Marieberta , Stephen Saneese , Baumgartner Karen , Wu Jimin , Liu Diane D , Yennu Sriram , Bruera Eduardo 
Published: February 2017

197 Background: Inpatients with cancer frequently undergo conversions from IV to PO hydromorphone (HM) or opioid rotation (OR) from IV HM to another PO opioid prior to discharge. Currently used conversion ratios (CR) between IV and PO HM range from 2-5 and opioid rotation ratios (ORR) between IV HM and oral morphine equivalent daily dose (MEDD) range from 10-20. This large variation in ratios may lead to uncontrolled pain or overdosing. Our aim was to determine the accurate CR from IV to PO HM and ORR from IV HM to PO morphine and oxycodone (measured as MEDD). Methods: We reviewed records of 4745 consecutive inpatient palliative care consults in our institute during 2010-14 for patients who underwent conversion from IV to PO HM or OR from IV HM to PO morphine or oxycodone. Patient characteristics, symptoms and opioid doses were determined in patients successfully discharged on oral opioids without readmission within 1 week. Linear regression analysis was used to estimate the CR or ORR between the 24 hour IV HM mg dose prior to conversion to PO and the oral opioid mg dose used in the 24 hours prior to discharge. Results: Among 394 eligible patients on IV HM, 147 underwent conversion to PO HM and 247 underwent OR to oral morphine (163) or oxycodone (84). Mean age was 54 years, 39% were male, and 95% had advanced cancer. Median time between conversion to PO and discharge was 2 days. In 147 patients the median CR (IQR) from IV to PO HM was 2.5 (2.1-2.7) and correlation of IV to PO dose of HM was .95 (P < .0001). The median CR was 2.5 in patients receiving < 30mg of IV HM/day and 2.1 in patients receiving ≥ 30mg of HM/day (P = .004). In 247 patients the median ORR (IQR) from IV HM to MEDD was 11.5 (10-13) and correlation of IV HM to MEDD was .93 (P < .0001). The median ORR was 11.5 in patients receiving < 30mg of IV HM/day and 9.9 in patients receiving ≥ 30mg of HM/day (P = .0004). ORR from IV HM to MEDDs obtained from morphine (11) and oxycodone (12.1) were significantly different (P = .0023). The CR and ORR were not significantly impacted by other variables. Conclusions: The median CR from IV to PO HM is 2.5 and ORR from IV HM to MEDD is 11.5. This implies that 1 mg IV HM is equivalent to 2.5 mg PO HM and 11.5 mg MEDD. HM may cause hyperalgesia at doses ≥ 30 mg/day and thereby requires a lower ORR to other opioids.
Time trade-offs in advanced ovarian cancer.
Authors: Wenzel Lari B. , Mukamel Dana B , Cohn David E. , Havrilesky Laura , Wright Alexi A. , Lipscomb Joseph , Sparks Lisa , Ladd Heather , Osann Kathryn 
Published: February 2017

20 Background: Most women with advanced ovarian cancer develop recurrence and die within five years of diagnosis. This creates a clinical imperative to discuss tradeoffs between the risks and benefits of treatment options. The purpose of this study is to examine the experience of ovarian cancer patients presented with a decision aid leading them through a time-tradeoff (TTO) exercise to guide choice of therapy. Methods: Newly diagnosed advanced ovarian cancer patients (N = 64) participated in a study evaluating the effectiveness and usefulness of a Patient-Centered Outcome Aid (PCOA). This i-Pad based interactive aid included an exercise during which patients evaluated personal tradeoffs between longer survival and adverse events associated with chemotherapy, in consultation with providers. Patients were educated about potential side effects, asked to rank their concerns about each side effect, and then asked: “Now that you have thought about and ranked the side effects, we ask you to think about the worst side effect for you as it relates to survival in good health. Would you be willing to go through 6 months of your worst side effect, if it gave you 5 years of good health?” There was a forced choice (Yes vs. No); then the tradeoff question was repeated with decreasing survival times: i.e. 3 years, 1 year, and 9, 6, 5, 4, 3, 2, and 1 months. Results: Of the 61 patients who responded to the TTO question, 52% required 1 or more years of good health to endure 6 months of their worst side effect. Among the non-neoadjuvant patients (N = 50), 18% indicated they would trade 6 months of the worst side effect for 1-2 months of additional life in good health, however 56% would require 9 months or more. While 95% of patients found it easy to rank order concerns about side effects, 75% considered the TTO question difficult to answer. Conclusions: Decisions aids which incorporate tradeoffs must be designed with sensitivity to differential health literacy levels, and the extremely personal nature of this decision.
Patterns of radiation therapy technology use in the treatment of bone metastases.
Authors: Chan Matthew , Olson Robert Anton , Lefresne Shilo , McKenzie Michael R. 
Published: February 2017

211 Background: In recent years, there has been a transition from two-dimensional radiation therapy (2DRT) planning towards more advanced techniques such as three-dimensional conformal radiation therapy (3D-CRT), volumetric modulated arc therapy (VMAT), and stereotactic body radiation therapy (SBRT). Our study aim was to analyze these trends in the treatment of bone metastases. Methods: All patients aged 18 and older who had received palliative intent RT for bone metastases between 2009-2014 and referred to any 1 of 6 regional cancer centers in British Columbia, Canada were reviewed. Summary statistics were used to describe radiation technique patterns. Logistic regression modeling was used to assess the influence of demographic, clinical, and health services variables on receipt of types of RT. Results: We identified 8,059 patients and 15,832 courses of RT; overall, 97.9% of courses were achieved by 2DRT and 2.1% by 3D-CRT, VMAT, or SBRT. Despite the low overall use of advanced techniques, its use was significantly higher in all subsequent years compared to 2009 (p < 0.05 for all years). The median age for patients treated with 2DRT was 67.0 (19-99) versus 66.0 years (19-93) for advanced techniques. There did not appear to be a statistically significant difference in age at the time of treatment start (OR 0.99; 95% CI 0.981-1.00, p < 0.05). Compared to lung cancers, thyroid (OR 9.9; 95% CI 5.197-18.724, p < 0.001) and kidney cancers (OR 3.9; 95% CI 2.508-5.911, p < 0.001) were significantly more likely to be treated with advanced techniques, while breast (OR 0.90; 95% CI 0.621-1.306, p = 0.58) and prostate cancers (OR 0.93; 95% CI 0.613-1.410, p = 0.73) were not any more likely. Compared to the Vancouver center, all other treatment centers in the province were utilizing advanced techniques less frequently. Patients were also more likely to complete RT with 2DRT than with advanced techniques (98.3% versus 95.8%, p < 0.05). Conclusions: The vast majority of treatment of bone metastases is still done by 2DRT in British Columbia. Despite these overall statistics though, a trend towards increasing use of more advanced techniques was observed.
The inclusion of palliative care in initial treatment planning for women with gynecologic cancer and the use of advanced directives.
Authors: Regn Rachel , Robinson William , Robinson William R. 
Published: February 2017

23 Background: To determine differences in Advanced Directive (AD) utilization among women with gynecologic cancer at a facility with a functioning Palliative Care (PC) program, vs those in a facility without access to a PC program. Also, to identify possible ethnic differences or relationships to other PC needs to AD utilization. Methods: 95 subjects with gynecologic cancer were prospectively identified, 30 from an inner-city academic facility (Site A), and 65 from a suburban community facility in the same metropolitan area. (Site B) All patients received treatment from board-certified oncologists. All subjects were approached by Master’s trained Social Workers at presentation with a diagnosis of cancer and asked to complete a standardized, validated questionnaire (modified Distress Thermometer (DT)) to determine their palliative care needs and whether they had an AD prior to treatment (baseline), and 6 months later. Completed questionnaires were collected and data was depersonalized and analyzed by the authors. Statistical differences were assessed using standard methods. Results: Site A patients were younger (56.3 vs 61.5 years) less likely to be Caucasian (12/30, 40% vs 40/65, 61.5%) and less likely to have private insurance (10/30, 33.3% vs 41/65, 63%). The presence of AD was similar in both sites at baseline. (8/65, 12.3% vs. 4/30, 13.3%) At 6 months, Site B patients were more likely to have an active AD. (50/65, 77.0% vs 5/30, 16.7%) No differences were seen based on ethnicity (Caucasian vs. Black) at either baseline or 6 months. No differences were seen based on the stage or type of gynecologic cancer. No relationship between AD utilization and any other PC needs (as recorded by DT) were identified. All differences were significant at a p < 0.05. Conclusions: Advanced Directive utilization is uncommon in women diagnosed with gynecologic cancer in the facilities analyzed. Subsequent creation of an AD is strongly associated with the presence of a PC program. PC programs have multiple benefits for gynecologic cancer patients, and should be offered routinely as part of the initial treatment plan.
Psychological distress and communication with children about a parent's advanced cancer: A mixed-methods study.
Authors: Hailey Claire Emery , Yopp Justin M , Deal Allison Mary , Mayer Deborah , Reeder-Hayes Katherine Elizabeth , Hanson Laura C , Grunfeld Gili , Rosenstein Donald L , Park Eliza M 
Published: February 2017

236 Background: Cancer affects 1.6 million parents with dependent children in the United States, many of whom experience heightened distress related to the impact of their illness on children. Palliative medicine and oncology providers frequently recommend open communication with children. However, there is little empirical research on the relationship between illness-related communication with children and parental psychological distress. The objective of this study was to explore the association between parental psychological distress and communication with children about a parent’s advanced cancer. Methods: This was a cross-sectional, mixed-methods observational study of patients with stage IV solid tumor malignancies who had at least one dependent biologic or adopted child. Participants completed the Hospital Anxiety and Depression Scale (HADS) and a semi-structured interview. Reports of illness-related communication with children were categorized as “minimal,” “partial,” or “full.” We conducted linear regression models to evaluate the association between extent of communication and HADS scores. Results: Of the 42 parents, 7 participants (17%) had minimal illness-related communication with their children, 13 (31%) had partial communication, and 22 (52%) had full communication including discussion of their prognosis. HADS Anxiety scores, but not HADS Depression scores, were higher with greater extent of communication (4.1 vs. 7.6 vs. 10.4, p = 0.003), even when controlling for performance status and children’s age. Conclusions: In this pilot study, parents who had more extensive communication with children about their advanced cancer and prognosis also reported more symptoms of general anxiety. Palliative and supportive care interventions should address psychological distress relevant to parenting and should provide guidance for communicating with children.
Female cancer patients’ awareness and role in family-based medical decision making mode in Confucian area.
Authors: Li Xing , Xing Yan-Fang , Lin Qu , Wei Li , Dong Min , Ma Xiao-kun , Chen Zhan-hong , Chen Jie , Ruan Dan-yun , Lin Ze-Xiao , Wang Tian-tian , Wu Dong-hao , Wu Xiang-yuan 
Published: February 2017

237 Background: Medical decision making of Chinese patients was family based, especially for female cancer patients. However, few studies have systematically investigated female patients. We aimed to illustrate the determinant of female cancer patients’ role in decision making. Methods: A total of 286 adult female cancer patients were included in this study between September 1st 2013 and December 31st 2013 from 13 leading general hospitals across China. A questionnaire was given 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 made decision with consensus of family members), and subordinate (those who usually don’t be involved in significant family issues). Results: Among the 286 cancer patients, only 29 (10.1%) patients made decision themselves. 221 (77.3%) patients delegated decision making to their family. The rest of 36 (12.6%) 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. Female patients as superordinate family members (4.5%), tend to play a positive role in medical decision. By contrast, patients with subordinate role in family (66.4%) persistantly play a passive role in medical decision making. Violation of medical recommendation increased according to the severity of patients’ prognosis. Cancer progression (90.6%), financial expense (65.7%) and life expectancy (94.1%) was always hidden from female patients by their families, especially for those with incurable disease. Conclusions: Medical decision making of female Chinese cancer patients was mainly family based. Female patients’ awareness of disease and participation in medical decision making was still needs improvement.
Experience of patient death and subsequent bereavement by members of the oncology team in the outpatient setting.
Authors: Easton Eve 
Published: February 2017

244 Background: Working with cancer patients is considered inherently stressful with high levels of burnout reported. There is limited research that focuses on the multidisciplinary team as a whole; research to date tends to focus on patient death from the perspective of the bedside oncology nurse, the physician or social worker. With the focus on those disciplines individually, thereby ignoring the centrality of the multidisciplinary nature of oncology care and excluding fundamental team members who provide care and are potentially impacted by the death of the patient. What is evident in current research is that long term meaningful relationships are developed between members of the multidisciplinary team and patients, with the consequences and implications of unresolved or unacknowledged grief being well documented as burnout and compassion fatigue. It is suggested that better support, acknowledgement of patient death and grief has implications for individual staff wellbeing, for staff training, support and the healthcare system, all of which have impact on the quality of patient care, improve retention, decrease burnout and compassion fatigue. The aim of this research is to explore the experience of death and subsequent bereavement from the perspective of those healthcare professionals who provide direct patient care at an outpatient oncology clinic. Methods: A qualitative study using a phenomenological approach was conducted to explore multidisciplinary team members experiencing regarding patient death and subsequent bereavement in the outpatient oncology setting. Individual interviews were conducted with 11 members of staff from 5 oncology teams based in the outpatient clinic of a magnet designated hospital. Results: Qualitative analysis yielded the following themes: insight, mortality, relationships, communication, grieving and bereavement, training and education, support and coping. Conclusions: To understand how patient death affects team members who provide patient care and support mechanisms used. Participants identified a need for acknowledging patient death in the work environment and had multiple suggestions for creating a supportive environment.
Association between abdominal adiposity, muscle mass, and metabolic syndrome in survivors of testicular germ cell cancer.
Authors: Thein Kyaw Zin , Osai William , Tu Shi-Ming , Pagliaro Lance C. , Kim Jeri , Yeung Sai-ching J. 
Published: February 2017

250 Background: Testicular germ cell tumor survivors (TGCTSs) contend with treatment side effects for decades after cure, and many have metabolic syndrome (MTS), a modifiable cardiometabolic risk factor. Because reliably predicting MTS could prompt interventionreducing risk, we analyzed clinical data and body composition in computed tomography (CT) scans to identify associations. Methods: In a retrospective review of 196 TGCTSs treated at a single institution from 1970 to 2007, we collected patient (pt) demographics, clinical data, body fat composition measures, and evidence from CT scans from baseline through posttreatment. NIH Image J was used to analyze cross-sectional CT images and measured subcutaneous adipose tissue, visceral adipose tissue, and skeletal muscle. Visceral fat-to-muscle ratio (VMR), visceral-to-subcutaneous fat ratio (VSR), and change in VMR and VSR from baseline to 3 to 5 years posttreatment (ΔVMR and ΔVSR) were calculated. We also gathered posttreatment glucose, blood pressure, lipid data, and body weight and height measured at time of scans. The 2001 U.S. National Cholesterol Education Program Adult Treatment Panel III guideline defined MTS. Univariate and multivariate logistic regression analyses identified associations. Results: Of the 167 pts included in the final analysis, 37.7% had MTS, 76.6% were white, and 68.9% had chemotherapy. Pts with MTS had significantly higher VMRs (p = .007) and VSRs (p = .021) than those without. Pts receiving chemotherapy and radiotherapy were significantly more likely to have MTS (p = .044 and p = .037). A multinomial logistic regression model including year of diagnosis, age, race, tumor histology, treatment, VSR, and VMR identified the association of high VMR and VSR with MTS; ΔVMR and ΔVSR were not statistically significant predictors. Conclusions: Body composition analyses identified VMR and VSR as significant predictors of MTS.