bluuebunny/crossref_metadata_2025_split huggingface dataset:
Palliative Care Early and Systematic (PaCES): A survey of colorectal cancer clinicians of barriers and facilitators to early palliative care integration.
Authors: Watanabe Sharon , Sinnarajah Aynharan , Earp Madalene , Tang Patricia A. , Kerba Marc , Simon Jessica 
Published: November 2017

128 Background: Health systems struggle to systematically provide early and integrated palliative care (PC) to cancer patients. In Alberta, Canada, the PaCES (Palliative Care Early and Systematic) project is addressing this need by building an early PC pathway for advanced colorectal cancer (CRC) patients. As part of this work, we aimed to characterize barriers and facilitators to: a) providing primary palliative care to CRC patients; b) referring CRC patients for PC specialist consults; and c) working with specialist PC and home care services. Methods: This observational, knowledge translation questionnaire study collected both quantitative and open-ended responses from physicians, nurses and other allied health care professionals (HCP) working with advanced CRC patients in Alberta, Canada. Survey questions and format were informed by Michie’s Theoretical Domains Framework. The strength of this framework is that, in addition to identifying specific barriers to delivering early PC, it also maps out suggested solutions to addressing these barriers. Results: The survey response rate was 43% (65/150). 89% of the respondents were physicians or nurses with Medical Oncology as the primary discipline. Time and competing priorities were the biggest barriers to HCPs addressing patients PC needs (65%). Next, role confusion when working with PC teams, and lack of clear process for executing new orders when patients are at home, were identified by over 55% of HCPs as a barrier. Other aspects of working with PC teams, including, lack of standardized communication processes and inadequate documentation processes, were barriers as perceived by over 45% of HCPs. Over 90% of HCPs surveyed believe earlier PC is likely to benefit their patients, and would recommend an earlier PC pathway to their patients. Conclusions: In Alberta, the main barriers to early PC integration are no longer attitudinal, with over 90% believing that early PC is beneficial for their patients. Time needed to address PC needs in a busy oncology clinic is a barrier. A pathway to improve clarity around referral processes and role confusion when working with PC teams will be developed to address these barriers.
Comprehensive distress screening and referral at a tertiary cancer center.
Authors: Loggers Elizabeth Trice , King Stephen Duane Watkins , Fann Jesse R , McMillin Kerry K , David Jodie HN , Harlow Lexi M , Horak Petr , Yi Jean C , Kusnir-Wong Tracy , Jagels Barbara , Shannon-Dudley Moreen 
Published: November 2017

134 Background: Addressing distress in cancer patients is now broadly recognized as critical to well-being and associated with increased survival. Cancer centers are developing innovative distress screening methods; we describe our novel process and results. Methods: New patients from 9/2015 to 3/2017 received an email requesting completion of a 44-item web-based survey assessing depression (2-item Patient Health Questionnaire), anxiety (2-item Generalized Anxiety Disorder), quality of life (QOL, 28-item Functional Assessment of Cancer Treatment-General), malnutrition (3-item Malnutrition Screening Tool), and 9 items addressing existential crisis, physical function, symptoms, tangible needs and concerns for dependent children. Results were computer scored, with positive screens resulting in direct, automated referrals to supportive care services (SCR). Analysis includes descriptive statistics and logistic regression using SAS 9.4. Results: 71% (n = 2629 of 3724) of those approached provided an email and completed the survey; 73% reporting no survey burden. Non-responders were more likely to be minority, non-English speaking, with non-commercial insurance (all p < 0.001). 59% (n = 1543) of responders screened positive for one or more SCR, including 6% to palliative care for poor QOL or symptoms. Receipt of SCR was more likely with Medicaid insurance (1.36 odds ratio [OR], 95% confidence interval [CI] 1.06-1.76, p = .0061); plan to receive care (1.27 OR, CI 1.07-1.50, p = .0061); and any report of survey burden (2.26 OR, CI 1.83-2.80, p < .0001). Conclusions: Web-based distress screening is feasible, efficient and not burdensome for the majority of cancer patients. Those who find this screening burdensome are two-fold more likely to have distress. Future efforts should address screening of vulnerable populations.
Characteristics of urgent palliative cancer care consultations encountered by radiation oncologists.
Authors: Fareed Muhammad Mohsin , Krishnan Monica Shalini , Spektor Alexander , Huynh Mai Anh , Khouj Yaseer Mohammed , Hertan Lauren Michelle , Nichipor Alexandra , Balboni Tracy A. 
Published: November 2017

135 Background: Palliative radiation therapy(PRT)is often employed in patients with advanced cancers requiring urgent consultation given the rapidity of presentation.We report on characteristics of urgent palliative oncologic issues encountered by radiation oncologists(RO). Methods: We prospectively evaluated patterns of presentation in162 consecutive consultations for urgent PRT at 3 centers from 5/19/14 to 9/26/14.Survey of palliative care issues was completed by physicians/nurse practitioners including assessment of reasons for urgent radiation oncology consultation,disease presentation characteristics and site of RT delivery.Response rate was 86% with 140 of 162 responses received. Results: Median age of patients was 63 years(29-89)with 39% > 65, 41% from 50-65 and 20% < 50 years;56% were males and 44% females. Most were married(62%)and 30% non-Caucasians.48% had ECOG PS 0-1,whereas it was 2, 3 and 4 in 24%,9% and 3%.Primary cancer diagnoses were lung (28%),breast(13%),prostate(10%),melanoma(10%),sarcoma(7%) and other diagnoses in 32%.Pain was predominant reason for consult(57%)followed by brain metastases(29%),spinal cord/cauda compression (13%),dyspnea (10%),bleeding (8%),bone fracture(4%)and dysphagia(2%).Clinicians managed pain (69%),neurologic symptoms(51%),fatigue (49%),intestinal(21%),respiratory (19%) symptoms,bleeding (14%),insomnia (13%),nausea/vomiting(12%)and dysphagia(6%).Patients presented at all stages 79% at the time of their diagnosis of metastatic cancer,63% with an established ( > 1 month) metastatic cancer diagnosis and continuing to further cancer therapies and 17% proceeding to hospice care without further anti-cancer therapy after PRT. Conclusions: Radiation oncologists care for patients across time course of metastatic cancer diagnosis managing variety of urgent oncologic issues,most commonly metastases causing pain followed by brain metastases and cord compression.They also manage cancer-related symptoms,mostly pain,neurological symptoms and fatigue.These findings point to need for palliative care to be well integrated into radiation oncology practice including education and systems of care.
Triple threat of mortality among advance cancer patients presenting to an emergency department.
Authors: Elsayem Ahmed F. , Warneke Carla L. , Reyes-Gibby Cielito C. , Page Valda D , Buffardi Luke Joseph , Brock Patricia A. , Chaftari Patrick , Alagappan Kumar 
Published: November 2017

138 Background: Early identification of cancer patients with short survival will help address end of life issues and avoid costly interventions. Dyspnea, delirium, and poor performance are known to predict short survival in palliative care. Our goal is to test whether these 3 conditions could predict mortality in the emergency department (ED) setting because a shorter tool would be practical. Methods: We randomly selected 243 English-speaking patients with advanced cancer who presented to the MD Anderson hospital ED and who were judged clinically stable. Patients were assessed for the presence of delirium (Confusion Assessment Method and Memorial Delirium Assessment Scale), poor performance (Eastern Cooperative Oncology Group score 3 or 4), and dyspnea (MD Anderson Symptom Inventory shortness of breath score > 5). All measures (survival and symptom) were available for 212 patients. Triple threat was defined as the presence of one of more of the 3 conditions: delirium (by either tool), poor performance, or dyspnea. We obtained survival data from medical records. Results: The table below shows each condition frequency, predicted probability of 30-day survival, and median OS. In pairwise comparisons adjusting for multiple comparisons, participants with 2 or more of the symptoms had poorer 30-day survival and OS. Conclusions: Patients with advanced cancer who have at least two of the triple threat conditions should have early discussion of goals of care to avoid costly and aggressive interventions. Further research including clinically unstable patients should be performed. [Table: see text]
Access to early palliative care in a cancer center in Mexico.
Authors: Alcalde Castro Mirza , Soto Perez De Celis Enrique , Covarrubias-Gómez Alfredo , Navarro-Lara Africa , Sánchez-Román Sofía , Pérez-Montessoro Viridiana , De La O Murillo Andrea , León-Rodriguez Eucario , Chávarri-Guerra Yanin 
Published: November 2017

139 Background: Early palliative care (PC) improves the outcomes of patients with advanced cancer, and ASCO has issued guidelines to encourage the integration of PC into standard oncology care. However, even in developed nations, many patients fail to obtain a timely PC evaluation. We reviewed current practices in the assessment of PC needs and use of PC services in a cancer center in a developing country. Methods: All patients with newly diagnosed advanced solid tumors seen at the National Institute of Medical Science & Nutrition in Mexico City from 10/2015 to 03/2016 were included. Demographic and clinical characteristics, data regarding assessment of PC needs, and referrals to PC services were retrospectively obtained from chart reviews for the first year after diagnosis. Frequencies and summary statistics were utilized. Results: 77 patients were included (median age 62 years; range 19-88; 55% male). 53% had gastrointestinal, 21% genitourinary, and 16% other tumors. The most commonly assessed symptom by oncologists (in at least one visit) was pain in 77% of patients, followed by anorexia (75%), fatigue (70%), nausea (57%), dyspnea (28%), and depression/anxiety (13%). 30% of patients were referred to PC in the first year after diagnosis. Median time from diagnosis to PC referral was 138 days (range 25-467). The most common causes for PC referral were pain (38%), delirium (23%), dyspnea (20%) and fatigue (20%). Only 1% of patients completed advance directives. 42% died during follow-up, of which 38% had previous PC visits. Median time from first PC visit to death was 15.5 days (range 1-70). Median time from last chemotherapy to death was 72.5 days (range 2-1201). Conclusions: Less than a third of the patients were referred to PC early in the course of their disease, and many PC needs were not routinely evaluated. Novel strategies are needed to improve access to early PC in developing countries.
Hospitalization costs for nausea and vomiting: A savings opportunity.
Authors: Roeland Eric , Ma Joseph , Binder Gary , Goldberg Robert , Paglia Robert , Knoth Russell L. , Schwartzberg Lee Steven 
Published: November 2017

155 Background: Nausea and vomiting (NV) are tracked by CMS as 2 of 10 top drivers of potentially avoidable hospital admissions for patients with cancer. These admissions pose a savings opportunity, yet limited literature exists on the costs of chemotherapy-induced NV (CINV). Burke’s 2010 assessment of 19,139 patients from 2004-2007 found CINV hospitalizations cost $7,448 and comprised the majority of overall CINV events and costs vs ambulatory events. Rashid (2016) evaluated 1,682 patients with metastatic breast cancer from 2007-2011 and found CINV admissions cost $10,074 in 2013 US dollars. Using data from the US Agency for Healthcare Research and Quality ’s Healthcare Cost and Utilization Project website (HCUPnet), and after applying adjustment factors from recent literature, we evaluated the cost of NV hospitalizations. Methods: Data on US hospital discharges for NV (based on primary discharge diagnosis) were obtained for 2014 from HCUPnet. Charges were adjusted using Smith’s (2015) model showing commercial insurers paid 48.7% of their hospital charges. They were further modified to include professional fees equaling 26.4% of facilities paid amounts, as reported by Peterson (2015). The CPI-Medical rate was used to adjust costs to 2016 dollars. A US payer perspective was used. The proportion of total NV discharges due to CINV is not known; it is also unknown whether charges for CINV differ from those for NV overall. Results: HCUPnet reported 37,730 hospital discharges for NV, with mean charges of $23,603 per event. The mean payment to hospitals, after adjustment to reflect amounts insurers actually paid, was estimated at $11,232 per event. Adding physicians’ professional fees incurred in the hospital setting yet normally charged separately yielded a total hospitalization cost of $14,197 ($15,120 in 2016 US dollars). Conclusions: Hospitalization for NV is common and costly; adjusted paid amounts averaged > $15,000 per discharge, a level consistent with the CINV literature. This economic impact, in addition to the consequences for patients’ quality of life, suggests the need for continued advances in preventing CINV and optimizing compliance with national antiemetic guidelines, particularly for chemotherapy with high emetogenic potential.
Multidisciplinary osteoncologic approach to bone metastases: Analysis of a large, mono-institutional cohort.
Authors: Maruzzo Marco , Ahcene Djaballah Selma , Brunello Antonella , Falci Cristina , Zovato Stefania , Schiavon Stefania , Nena Ugo , Galuppo Sara , Parisi Alessandro , Aliberti Camillo , Ruggieri Pietro , Zagonel Vittorina 
Published: November 2017

159 Background: Bone metastases are responsible for high morbidity in patients (pts) with a strong clinical impact. Recently, a new multidisciplinary approach called osteoncology has benn develped. No data on multidisciplinary management of large series of patients (pts) with bone cancer disease are available. Methods: We reviewed clinical data of all the consecutive pts evaluated from Apr 2013 to Dec 2016 in the multidisciplinary Osteoncology clinic of Istituto Oncologico Veneto. We collected clinical data on primary diasease, sites of disease, pain, bone clinical and radiological situation, assesment and medical decision taken in a multidisciplinary team. Results: 481 pts (303 F, 63%) have been evaluated by a multidisciplinary team composed by medical and clinical oncologist, pain specialist, endocrinologist, radiologist and ortopedic surgeon. Totally, 444 visits and 340 discussione have been performed. 422 pts (88%) had bone metastases, median age 65 years (range 34-89). 388 pts (92%) had vertebral metastases, 167 (39%) had pelvic bone disease, 201 (47%) had other site of bone disease including extremities. 186 (39%) pts had pain. We have prescribed a corset for 151 (31%) pts, radiation therapy for 202 (42%) pts with a median time from prescription to delivery of 15 days. Vertebroplastic has been prescribed in 66 (14%) pts with a median time for delivery of 7.5 days. 33 (7%) pts received indication to orthopedic surgery with a median waiting time of 15 days. For 115 pts data on pain at visit and 30 days later were available: 41 pts had no change in NRS, 11 pts had a worst paint (median NRS Δ = +2), 63 pts had a pain reduction (median NRS Δ = -3). 301 pts received a diagnosis of SRE. Median OS (mOS) was 80.9 months; at 2 yrs 91% of M0 pts vs 75.8% of M1 pts was alive (p = 0.0018); mOS for pts with a SRE was 70 vs 89.5 mos in pts without SRE (p = 0.033); among M1 pts, there was no significant difference from having or not a SRE. Conclusions: To our knowledge this is the first reported series of pts evalutated by an osteoncologic team. OS confirms that pts with SRE had a poorer outcome. Median time from prescrition to care delivery is shorter from data available in literature, conferming the positive impact for pts from multidisciplinary approach.
Optimizing dosing in navigation interventions across the cancer continuum: A planned secondary data analysis from the Patient Care Connect implementation.
Authors: Kvale Elizabeth Ann , Pisu Maria J , Williams Courtney , Kenzik Kelly , Azuero Andres , Sharma Pradeep , Halilova Karina I. , Rocconi Rodney Paul , Cantuaria Guilherme Henrique , Partridge Edward E. , Rocque Gabrielle Betty 
Published: November 2017

174 Background: Patient navigation programs in cancer care have historically focused on assisting persons to overcome barriers to accessing care. Evidence is emerging to support the impact of navigation interventions across the cancer continuum. However, navigation programs have varied designs, resulting in a lack of clarity about the optimal approach to delivering services to patients, and a lack of evidence linking program design to outcomes. Methods: A planned retrospective analysis of Medicare administrative claims for a population of older beneficiaries diagnosed with cancer: The main exposure was the number of contacts in person or over the phone with PCCP navigators in the 6 month period starting from the quarter in which patients enrolled in the PCCP. Repeated measures generalized linear models with normal distribution were used to evaluate trends in total cost over time based on: number of contacts, quarters post-enrollment (TIME), and the interaction between number of contacts and TIME. Intra-correlation was controlled for repeated measures. Results: 4,337 patients were included in this analysis. 17.9% had one contact, 17.7% had two, 22.2% had 3-4, 24.2% had 5-10, and 18.0% had more than 10 contacts. African Americans had a greater number of participants with more than 10 navigator contacts, as stage 4 cancers, and initial or end-of-life phase of care. Patients who received more than 3 contacts had significantly higher levels of baseline cost. Models to evaluate total cost over time demonstrate an effect of navigator contact on cost that is associated with number of contacts. This trend is statistically significant at 3-4 contacts or more, and remains significant at 10 or more contacts. Conclusions: Increased navigator contact is associated with increased slope of decline in utilization and cost indicates that navigation programs should be adequately resourced to deliver care that enables navigators to have contact with patients a minimum of 3-4 contacts over a six month period.
Spirituality among Latino caregivers of patients with advanced cancer: A qualitative study.
Authors: Delgado-Guay Marvin Omar , McCollom Susana , Palma Alejandra , Duarte Eva Rossina , Grez Monica , Tupper Laura , Bruera Eduardo 
Published: November 2017

180 Background: Caregivers of cancer patients often face significant physical, social, and emotional distress. There has been limited research on the association between Latino Caregivers’ spirituality/religiosity, meaning, and spiritual pain. Methods: We interviewed 336 Latino Caregivers of patients at Palliative Care clinics in Chile, Guatemala, and the US. Five open-ended questions were asked about spirituality, religion, meaning, and spiritual pain. Answers were transcribed and data analyzed. The analytic framework was based on an interpretive phenomenological analysis. Initial themes were grouped into themes, connections between themes were developed until a thematic rationale was achieved. Results: Latino caregivers’spirituality and religious beliefs were described as an anchor during the painful witnessing of a loved-ones’suffering. Main themes emerged about relationships, inner strength, hope, and acceptance/reconciliation. It was reported as an integrative force to help them to cultivate hope and love walking through their love one’s illness and their journey as caregivers. They expressed meaning as a manifestation of spirituality together with their love to others(spouse, family, others). The presence of Spiritual Pain was common and manifested as suffering and potential loss of loved ones, and broken relationship with Higher Power, that triggered a profound experience of their own pain(both spiritual and emotional) and their own quality of life. This was expressed in physical terms such as “heartache” and “soul ache.” Through discernment, prayer, and relationships with loved-ones, spirituality was integrated as a healing force during the caregiver journey. Spirituality was reported as a substance of hope weaved into an integrative process, as caregivers reconciled the tension of faith with sorrow. Conclusions: Spirituality and religious beliefs are reported as fundamental for Latino Caregivers. Despite these elements, Spiritual Pain is common and affects all aspects of their humanity. Most of them experienced a reconciliation experience with the broken relationships with themselves, with others or with Higher Power.
Integration of spiritual care services along with supportive care clinic in a comprehensive community cancer center.
Authors: Chandra Abhinav Binod , Carlson Laree , Alvarez Angelic , Kumar Vivek , Elnadry Jeanne 
Published: November 2017

181 Background: A grave illness like cancer can lead to substantial spiritual distress for patients and their care givers. Not meeting patients’ spiritual needs have been reported to lower ratings of quality and dissatisfaction with care. The FACIT-Sp-12 is used in research studies investigating health related quality of life (HRQOL) outcomes in cancer patients and has special focus on faith, meaning and peace. Methods: We introduced a unique model at the cancer center by having the chaplain resident and pain/palliative care physician evaluating and following patients together during the weekly Supportive Care Clinic. FACIT-Sp-12 score was also calculated for 92 patients on 164 visits during October 2016 till July 2017. Results: Overall, the FACIT-Sp-12 score was calculated for 92 (52 females and 40 males) patients with median age of 69 years (range 36-89). Sixty-eight (74%) were non-Hispanics while native language was English for 71 (77%) patients. The baseline FACIT-sp-12 score ranged between 16 and 48 with median score of 38. Thirty-two patients had follow up visits. 15 of these patients had improvement in their FACIT-Sp-12 score, 12 patients’ score had decreased and 5 patients’ scores were unchanged. There was an increase in FACIT-Sp-12 score in the males but after adjusting for gender, age, race, language and number of follow up visits, none of the variables could predict increase in the FACIT-Sp-12 score. Conclusions: We have successfully implemented this model of integrating spiritual support services to the delivery of cancer care. Decrease in FACIT score may coincide with distress associated with worsening symptoms or change in patient’s condition, and offers an opportunity to address the increased spiritual needs and assistance with coping during times of distress. Future prospective studies will prove instrumental in validating this approach and hopefully become a service reimbursable by health insurances, and thereby become universally accessible.