bluuebunny/crossref_metadata_2025_split huggingface dataset:
The level of soluble programmed death ligand-1 in lung cancer: An exploratory biomarker study.
Authors: Geng Rui , Pan Li , Guo Sutang , Jing Jiexian , Zhang Xu Dong , Song Xia 
Published: February 2017

249 Background: A new approach to immunotherapy based on programmed death 1 (PD-1) and programmed death ligand-1 (PD-L1) pathway represents a remarkable innovation in lung cancer treatment. There is growing evidence that lung cancer cells exploit the PD-L1 to cause local immune-suppression. The aim of this prospective study was to investigate the prevalence and prognostic roles of soluble PD-L1 (sPD-L1) protein in the blood of patients with lung cancer. Methods: A total of 159 patients with lung cancer who were diagnosed by histopathology or cytopathology between July 2013 and October 2015 were enrolled. Blood samples plasma were collected at the time of diagnosis. 85 samples of healthy subjects matching in sex and age from the Health care Center of the hospital were also studied as control. The level of sPD-L1 protein in the blood was measured using an enzyme-linked immunosorbent assay (ELISA). 64 cases of patients with lung cancer who were treated with platinum based chemotherapy for 4-6 cycles were followed up. The median follow-up duration since the time of diagnosis was 18.6 months (range, 4-26.6 months). The associations between the level of sPD-L1 expression and clinicopathologic features and prognosis were statistically analyzed. Results: Expression of sPD-L1 in patients with lung cancer was significantly up-regulated compared with health people (P < 0.001). A cut-off value of 2.37ng/ml was distinguished in patients according to Receiver operating characteristic curve (ROC). The expression of sPD-L1 was associated with abdominal organ metastasis (P = 0.015). A high sPD-L1 expression had a worse prognosis than a low expression in patients (13.4 months vs 19.8 months, P = 0.001). Conclusions: Our results indicated that plasma sPD-L1 protein was elevated in patients with lung cancer and was associated with a poor prognosis. Plasma sPD-L1 protein is a potent predicting biomarker in lung cancer and may play a pivotal role in tumor immune evasion.
Perception of helpfulness of a question prompt sheet among cancer patients attending outpatient palliative care.
Authors: Arthur Joseph Anthony , Yennu Sriram , Perez Zapata Kresnier , Cantu Hilda , Liu Diane D , Wu Jimin , Bruera Eduardo 
Published: February 2017

25 Background: Data on the use of question prompt sheets (QPS) in palliative care is limited. Our team previously developed a single page QPS using a Delphi process. The main objective of this study was to determine the perception of helpfulness of a QPS in patient-physician communication among advanced cancer outpatients. Methods: 104 eligible patients received the QPS for use during their first palliative care clinic. Patient and physician perceptions about the QPS were assessed at the end of the visit. Patients’ anxiety was also measured pre- and post-consultation using the Spielberger State Anxiety Inventory. Results: 100/104 (96%) patients completed the study. Among those responders, most agreed that the material was helpful in communicating with their doctor (77%), clear to understand (90%), had the right amount of information (87%), and they would use a similar material in the future (76%) and recommend it to other patients(70%). Overall, 92% were satisfied with their consultation visit. Physicians perceived that the QPS was helpful to 68% of the encounters and it did not prolong the consultation in 73% of the encounters. Physician agreement on helpfulness of the QPS was not significantly different from the patients (p = 0.3). Patient anxiety improved after consultation from a mean (SD) STAI score of 39.2 (12.8) to 33.8 (10.7), p ≤ 0.0001. Conclusions: The QPS was perceived as helpful in patient-physician communication among advanced cancer outpatients and it did not increase patient anxiety. Physicians similarly reported that the QPS was helpful and it did not prolong clinic visits. Further research is needed for its widespread adoption and integration into routine clinical practice.
Symptom burdens and coping strategies in adolescent and young adult (AYA) cancer survivors with hematologic malignancies.
Authors: Hlubocky Fay J. , Muffly Lori S. , Gomez Joseline X. , Breitenbach Kate , McNeer Jennifer Lynn , Stock Wendy , Daugherty Christopher 
Published: February 2017

256 Background: Prior research reveals that AYA survivors face significant short-term and long-term physical and psychological symptom burdens (SB) as a result of disease and treatment. Yet, the prevalence of SB and their effect on AYA coping in hematologic survivors has not been described. Methods: AYA patients (15-40 years at diagnosis) of acute leukemia, aggressive non-Hodgkin lymphoma, and Hodgkin lymphoma undergoing curative intent therapy (on-treatment cohort) or 2 year completion of therapy and in remission (early survivor cohort) completed following measures: depression (CES-D), state anxiety (STAI-S), PTSD (PCL-C), HRQOL (FACIT-G), Coping (Brief COPE). Semi-structured interviews evaluated symptom burdens. Results: To date, 60 AYA subjects (26 on-treatment, 34 early survivors) were interviewed. For total population: median age at diagnosis 25y (15-40); 63% male; 58% Ca; 79% college/postgrad educated; 40% income < $75,000yr; 51% and 48% lymphoma or leukemia dx, respectively. Median time from diagnosis to interview was 13 months (1-102). In general, 56% AYA reported experiencing current physical (e.g. pain, sleep) SB and 58% AYA experienced psychological (e.g. anxiety) SB. AYA on treatment reported moderate STAI-S anxiety (35.0 ± 10.3 v 31 ± 10.2, p = 0.03); and CES-D depression (21 ± 12.1 v 10.4 ± 8.0, p = 0.01). AYA on treatment had poorer overall FACT-G health-related QOL (76.5 ± 12.8 v 82.3 ± 17.0, p = 0.02). Re coping, AYA on-treatment with depression scored highest on self-blame (5.2 ± 2.7; range: 3.5-6.8). AYA on-treatment with anxiety scored highest on denial (4.3 ± 2.1; range: 1-6). AYA in remission reported severe illness-related PTSD symptoms (58 ± 24.3 v 29.4 ± 9.5, p = 0.01). Re coping strategies, AYA in remission with PTSD scored on average significantly higher on: denial (6.5 ± 3.2; range 4.6-8.0); self-blame (6.6 ± 2.3; range: 4.2-7.9) and substance use (5.9 ± 2.1; range: 2.9-8.0). Conclusions: AYAs with hematologic malignancies report experiencing significant physical and psychological SB in the short and long-term. Early integration of palliative care targeting these SB should be incorporated into routine cancer as well as survivor care.
Coping with moderate to severe chronic graft-versus-host disease (cGVHD) among hematopoietic stem cell transplant (HCT) survivors: A qualitative analysis.
Authors: Fishman Sarah , El-Jawahri Areej , Traeger Lara , VanDusen Harry , Chen Yi-Bin Albert , Temel Jennifer S. , Driscoll Jessica 
Published: February 2017

257 Background: HCT survivors with moderate to severe cGVHD experience substantial symptoms, which negatively impact their quality of life. However, data are lacking on how patients cope with their illness. We aimed to achieve a deeper understanding of patients’ illness perception and how they cope with their cGVHD. Methods: We conducted qualitative interviews with 14 HCT survivors with moderate to severe cGVHD as defined by NIH Consensus Criteria. We used a semi-structured interview guide to elicit patients’ illness perception and coping strategies. Two raters coded interviews independently. We used content analysis to identify themes. Results: Patients highlighted two key themes in their efforts to cope with what they perceived as a “full time job” dealing with their cGVHD: personal transformation and empowerment. With respect to transformation, patients expressed the importance of (1) changing the goal of care from recovery to coping with a chronic condition, and (2) seeking new sources of support and connectedness specifically from other patients and caregivers affected by cGVHD. With respect to empowerment, patients sought more information and understanding about cGVHD in order to gain more control over their symptoms and illness experiences. Patients also noted the importance of knowledge and control in coping with their disease. By seeking knowledge and a greater understanding of their disease, patients explained that they felt that they were gaining control and feeling more empowered. Through the lens of change, it is clear that all patients sought an evolution in their care perspective by increasing care motivation, creating active support webs, and seeking further involvement in their own care. Conclusions: The diagnosis and course of cGVHD is psychologically transformative for patients. Although patients demonstrated an understanding of how they cope with the psychological and physical burden, they also expressed a wish for more education, support and a method of connecting with other HCT survivors. Future interventions should focus on enhancing patients’ coping strategies, knowledge of their illness and connections with other HCT survivors.
Benefits of cover makeup for survivors.
Authors: Wakeda Takako , Heike Yuji 
Published: February 2017

259 Background: Cancer therapy causes various appearance changes, such as chemotherapy-induced alopecia and skin pigmentation. These events decrease cancer survivors’ QoL (quality of life), and sometimes deprive them of social life and work opportunities. Even though wigs are commonly accessible to care hair loss, the way has not been established to care visual changes in skin. Our previous interview survey revealed that visual changes in skin depressed cancer survivors and their daily life were also interrupted, e.g., “I cannot go swimming with this wound” and “I don’t like to see anyone due to the pigmented face.” Therefore, we decided to try to adapt cover makeup technique for survivors in order to increase their QoL and recover their confident. This study was performed to examine whether “cover makeup” on the skin appearance changes could contribute to the patient with cancer’s QoL. Methods: Cover makeup was supplied for the cancer survivors, including a special cream that matched each individual’s skin color. The QoL values (Skindex-16 and visual analog scale) were compared before and 2–3 months after the first makeup instruction. The participants used cover makeup in this follow-up period freely. Results: Almost all visible changes in skin were completely concealed with cover makeup among 43 participants (breast, 23; thyroid, 11; stomach, five; leukemia, two; others, two), including only two male patients. Skindex-16 and visual analog scale values improved in all participants, regardless of the diagnosis, cause or site of skin problems. Conclusions: Using subjective scales, this study showed that cover makeup can improve patients with cancer’s QoL. Appearance changes caused by life-saving treatments tend to be dismissed but more attention should be paid to appearance care to enable patients with cancer to experience better QoL. Our results suggest that cover makeup is helpful and important for survivors’ daily living. Clinical trial information: UMIN000011652.
Is empathy associated with a derived sense of meaning among resident physicians working with patients nearing the end of life on a hematology-oncology ward?
Authors: McFarland Daniel Curtis , Komisar Jonathan 
Published: February 2017

28 Background: An association between empathy and physician-in-training based meaning derived from patient deaths has not been explored previously. If meaning is associated with empathy, an intervention to enhance meaning may counteract empathy decline and promote clinician resilience. This study sought to understand if empathy might be associated with the ability to find meaning in the clinical situations that residents face in oncology. Methods: Internal Medicine residents rotating on a Hematology/Oncology ward were asked “Do you derive a sense of meaning from working with dying patients? Yes or No.” The Interpersonal-Reactivity Index (IRI) was used to measure empathy and demographic information. Results: 64 responded (66.7% response rate). 43 (67.2%) derived a sense of meaning while 21 (32.8%) did not. The ‘meaning’ group empathy score (IRI) was 60.7 (SD 10.8) and the ‘no meaning’ group empathy score (IRI) was 51.7 (SD 11.5) (p < .01). Empathy subscale differences were notable for decreased cognitive empathy via the Fantasy Score (14.0 versus 9.9) (p < .01) and decreased affective empathy via the Empathic Concern scale (18.8 versus 15.9) (p < .05). Conclusions: The majority of physicians-in-training derived a sense of meaning from working with patients at the end of life and had significantly higher levels of empathy. The ability to impart meaning-finding has been demonstrated in patients and could be taught to physicians-in-training and lead to higher empathy levels. [Table: see text]
End-of-life discussions with advanced cancer patients and their effects on bereaved families’ mental health.
Authors: Yamaguchi Takashi , Maeda Isseki , Hatano Yutaka , Mori Masanori , Shima Yasuo , Tsuneto Satoru , Kizawa Yoshiyuki , Morita Tatsuya , Yamaguchi Takuhiro , Aoyama Maho , Miyashita Mitsunori 
Published: February 2017

3 Background: End-of-life (EOL) discussions are important for providing appropriate care to patients with advanced cancer at the end of their life. To explore the relationship between EOL discussions and bereaved families’ mental health, as well as the quality of the patient’s death and quality of care at the end of life. Methods: This was a nationwide questionnaire survey of bereaved families of deceased cancer patients who died at 75 sites (20 inpatient palliative care teams in acute hospitals, 33 palliative care units/inpatient hospices, and 22 outpatient clinics that provide home palliative care service) in Japan. 13,711 bereaved family members of cancer patients who died before January 2014 in each of the participating institutions were potential participants. We evaluated the prevalence and details of EOL discussions which were defined as “a discussion with physicians about the preferred place of death or resuscitation”. We also evaluated the prevalence of depression (defined as the Patient Health Questionnaire-9 ≥ 10) and complicated grief (defined as the Brief Grief Questionnaire ≥ 8) in bereaved families. Results: 9123 questionnaires returned (response rate 67%). Of those, 80.6% had EOL discussions. After propensity score weighted adjustment, bereaved families with EOL discussion less frequently developed depression (17.3% and 21.6% ; P < 0.001) and complicated grief (13.7% and 15.9% ; P = 0.03) than without. There were significant differences in the trend test among families without and in those with EOL discussions < 1, 1–3, and > 3 months before the patient’s death, for the prevalence of depression (21.6%, 20.6%, 16.8%, and 15.5%, respectively; P trend < 0.001) and complicated grief (15.9%, 16.4%, 12.8%, and 12.9%, respectively; P trend < 0.001). Conclusions: EOL discussions may contribute to decrease depression and complicated grief in bereaved families. EOL discussions should be initiated with advanced cancer patients when physicians expect a patient’s prognosis is limited to several months.
When 'home' means another nation: The power and pitfalls of repatriation at the end of life from a tertiary cancer centre.
Authors: Taylor Ros 
Published: February 2017

46 Background: How people die lives on in the memory of those who survive. It is therefore pivotal for palliative teams to help craft an ending in line with patient and family goals. It has been observed in a tertiary cancer centre that there is often a spiritual imperative for patients to return to their nation of birth, once treatment is stopped and mortality accepted. Methods: Retrospective chart review of 3 patients repatriated for end of life care to their nation of birth (Romania, Portugal, Ireland), focusing on: the conversations about the goal of repatriation and its meaning to the patient; the practical barriers and enablers of repatriation of patients with advanced cancer. Follow-up interview with bereaved families to establish impact of repatriation. Results: Chart review revealed multi-layered hesitant conversations, often facilitated by the palliative care team, to establish that getting ‘home’ meant returning to the country of birth. This became an overarching pre-occupation for the patient, family and team. Patients were not concerned whether they were transferred to a hospital, hospice or family home – it was the country that mattered. There was huge anxiety and little objectivity about fitness to travel. Nurses were more anxious than doctors. Patient and family expressed least anxiety. There was a knowledge deficit regarding fitness to fly, whether an escort was needed, the respiratory and metabolic effects of flight, and how to maximize wellbeing on the journey. Reassurance was gained if the transfer was to a hospital, with greater concern if the transfer was to a community setting. Follow-up interviews with bereaved families are still in progress. Initial findings suggest no regrets in terms of the decision to fly home, and that self-esteem improved with familiarity and social connection. Conclusions: The practical anxieties of health professionals often act as delays to repatriation at the end of life. Checklists to facilitate these journeys would ensure that the process does not need to be learnt each time, and that windows of opportunity are not missed. Achievement of spiritual goals for a loved one is hugely important to those who live on.
Management of the primary site in stage IV non-small cell lung cancer: SEER analysis.
Authors: Szeja Sean , Dandapani Savita V. 
Published: February 2017

52 Background: One of every three non-small cell lung cancer (NSCLC) patients is diagnosed with terminal stage IV disease. As systemic treatments have evolved, other tumor sites such as kidney have demonstrated benefits of aggressive management of the primary location and oligo-metastases. The purpose of this study is to use the SEER database to evaluate survival outcomes associated with surgery (S) and radiation treatment (RT) of the primary site in stage IV NSCLC. Methods: Eligible patient cases had lung coded as the primary location. The analysis was limited to histology of squamous cell carcinoma or adenocarcinoma, M1 staging, had recorded extent of surgery and status of radiation, were taken from years 1998-2013 and grouped from 1998-00, 01-05, 06-10, 11-2013 for temporal analysis. Kaplan-Meier was used to estimate median overall survival (MOS) and lung cancer specific survival (CSS). Results: There were 41150 patients meeting inclusion criteria with median follow up of 4 months limited by survival. Treatment was S only to 494, RT only to 20346, S+RT to 731 and neither to 19579. Of the dual modality patients, 85 had RT before S, 525 after and 121 unknown order. Node negative surgical patients undergoing lobectomy had better median OS & CSS (30 & 35 m respectively) than all other surgical categories (eg. wedge resection with 13 & 17m, pneumonectomy with 10 & 15m). Median OS & CSS decreased slightly from 5 to 3 and 6 to 4 months over the time from 2000-2013. In the subset with N0 disease, those receiving both S+RT observed an increase of median OS & SS from 11 to greater than 35 months (median not reached in 2013) while no trend was seen for other treatment strategies, which were ~5 months in 2013. Conclusions: Potential sources of confounding and bias must be regarding when interpreting our findings. These include selection of patient for aggressive treatment, both local and systemic, the latter of which this database does not describe. Our findings demonstrate that, in stage IV NSCLC, aggressive management of the primary site with surgery and radiation in patients with limited local disease such as N0 lymph nodes is associated with prolonged survival.
A whole greater than the sum of the parts: Close collaboration between palliative care and clinical ethics.
Authors: Sederstrom Nneka Obiajulu 
Published: February 2017

53 Background: The disciplines of palliative care (PC) and clinical ethics (CE) share common content but also important distinctions in method, skill set, and clinical role in a given patient encounter. Particularly in cases of advance care planning, complex decision-making, and clarifying goals oncology teams may be challenged to know which consultation service to involve. Methods: Case report and commentary. Results: A 60 year-old man with a 3-year history of glioblastoma multiforme presented with sudden onset right-sided weakness and altered mental status. In the emergency department, a computed tomography (CT) scan demonstrated a left-sided intracranial bleed with concomitant cerebral edema and left-to-right midline shift. The patient was admitted to a surgical intensive care unit (SICU) where neurosurgery declined to operate. Within hours of admission, while the patient’s son (also his durable healthcare power-of-attorney) was considering a do-not-resuscitate order, local police arrived at the hospital, having received a 911 call from the patient’s daughter who claimed her brother and medical providers were attempting to murder her father by shifting to comfort care. The SICU team urgently consulted PC and CE. Within an hour, PC and CE clinicians met with the patient’s family to review the patient’s advance directive, counsel regarding clinical management strategies and prognosis, broach comfort care, introduce hospice, and liaise with a hospice case manager. Additionally, PC collaborated with the SICU to provide best symptom management; CE worked with hospital risk management and security to ethically mitigate escalation of more reactive family members. Within 4 hours of the consults, the patient was being transferred to a local inpatient hospice facility, where he died several days later. Conclusions: As this case demonstrates, models of close collaboration between PC and CE consultative services may swiftly facilitate appropriate transitions in care for patients with advanced cancer and simultaneous de-escalation of hospital risk. Evolving models for quality supportive care should further examine such strategies.
End-of-life care for glioblastoma multiforme (GBM) patients at a large academic center.
Authors: Kuchinad Kamini , Wang Xiao , Wang Jiangxia , Evans Anne , Riley W. Anthony , Smith Thomas J. 
Published: February 2017

56 Background: GBM is a uniformly fatal disease with average survival of < 3 years and universal cognitive problems, making advance care planning paramount. End of life (EOL) patterns of GBM care in the US have not been studied. We examined care in a cohort of GBM and brain tumor (BT) patients as part of a program to provide individual provider feedback about EOL care. Methods: We reviewed the care of all GBM patients over 3 years with a random sample of 100, and a 5-yr subset of 45 who received their care at Gilchrist Hospice (GH), our largest provider. We queried EPIC EMR for markers of quality. We also reviewed all 452 advanced cancer pts of the Sidney Kimmel Comprehensive Cancer Center (SKCCC) referred to GH from 7/1/13 to 3/31/15 to find the median length of stay (LOS) and %LOS < 7 days for each division and each physician; 29 BT patients (most GBM) are included. Results: Few patients had documented Advance Directives or code status. Of the 100 pts, 37% were hospitalized in the last 4 weeks of life, and 17% received chemotherapy. Hospice referral and use was 76%. Of those in GH, 64% died at home with hospice and 20% died in inpatient hospice. Variability among physicians in hospice LOS was high (cv = 124.30%) ranging from 6 to 158 days with a median of 33.5 days, exceeding national averages, and 3 of 6 practitioners were below average LOS. Conclusions: In this snapshot of GBM EOL care in the US, improvements can be made in the use of advance care planning, code status, chemotherapy near death, and hospitalization rates. Hospice LOS is above national averages but varies by physician. [Table: see text]