bluuebunny/crossref_metadata_2025_split huggingface dataset:
Provider-survivor communication: Identifying and addressing unmet needs.
Authors: Patterson Angela K. , Escoffery Cam , Hotz James , Paris Nancy M. , Meyer Donna L. , Giblin Joan M. , Michaud Katherine S. , Kirsch Logan J , Wilson Barbara J. , Fournier Jennifer , Helmer Carolyn , Comer Catherine , Kines Joan , Heddon Mary Ann , Sidman Tobyanne , Moon Tamira M. , Cannady Rachel 
Published: February 2017

81 Background: The Georgia Cancer Control Consortium’s Survivorship Working Group conducted a needs assessment to understand physical, psychological, practical, and spiritual needs of adult survivors. Results were used to assess survivors’ level of distress and how effectively their needs were being met. Methods: Cross-sectional online and paper-based surveys developed using NCCN and Commission on Cancer (CoC) guidelines. Surveys were distributed through survivorship programs of CoC hospitals (n = 40) and cancer organizations via email, social media and mail. 740 responses received September-December 2014. Results: Respondents were primarily female (78%) married (65%), college-educated (55%) and insured (97%). 83% were White,16% were African American and 3% were Hispanic. 36% of respondents were within 1 year of treatment; 45% were 1 - 5 years post treatment. Survivors reported positive experiences with provider communication. Responses of ‘often’ or ‘very often’ were: provider gave them a chance to ask questions (90.6%); provider involved them in healthcare decisions (84.7%), provider spent enough time with them (78.5%) and provider helped with feelings of uncertainty about health issues or treatment (75.7%). Physical and emotional needs were not as effectively met as spiritual or practical needs. A higher proportion of survivors reported moderate to extreme levels of emotional distress with: depression (32.7%), anxiety (32.1%), stress (30.2%), fear of recurrence (28.2%) and defining a “new normal” (25.9%). 81% of survivors found information and assistance online (56%), in print materials (41%) and from providers/cancer centers (41%). 37% received a survivorship care plan (SCP); 98% reported the SCP was helpful. Conclusions: Results demonstrate the need for providers in Georgia to be educated about and responsive to survivors’ unmet needs and levels of distress. Survivors report positive communication with providers but lower levels of having physical and emotional needs addressed. Survivors actively seek resources and benefit from SCPs. Providers can contribute to addressing needs and reducing distress by maintaining strong communication, guiding survivors to evidence-based resources and implementing SCPs.
Implantable intravenous devices (“ports”) as a survivorship issue.
Authors: Opneja Aman , Rout Amit , Abraham Joseph , Gill Gurkirat , Miller Kenneth David 
Published: February 2017

9 Background: Women with early stage breast cancer often receive chemotherapy through implantable intravenous access devices (ports). There is little information on the duration of port use for breast cancer patients who have completed treatment. Methods: The EMR was searched for women who received adjuvant chemotherapy using a port for Stage I-III breast cancer between 2007- 2012. Data abstracted from the EMR included demographics, duration and type of chemotherapy, duration of port use and complications. Results: During the years 2007-2012, a total of 167 patients qualified for the study. 28 (16.8%) patients were excluded as complete data was not available. The Mean age of the remaining 127 women was 60 (SD: 1) years. The distribution of cancer stage was 18.1%, 59.1%, 22.8% of stage I, II, and III respectively. The median total length of duration of indwelling port was 506 days and median duration from chemotherapy completion to port removal was 299 days. The duration of time after completing treatment that the port remained in place was 0-6 months (31.5%), 6-12 months (25.2%), 12-24 months (24.4%), and > 24 months (18.9%). Patients with stage III cancer had significantly longer time to port removal relative to patients with stage I and stage II cancer (p < 0.005). Complications of ports (n = 4), all occurred during active treatment and included non-functioning/mispositioning (n = 2), and thrombosis (n = 2). Assuming the cost of port maintenance was $225 per visit and port maintenance was required every four weeks, the estimated average cost of maintaining the port after the completion of chemotherapy was $3,494 for this group of patients. Conclusions: Oncologists typically do not use the word “cure”; maintaining a port in place after chemotherapy may reinforce concerns about the risk of recurrence. This is highlighted by the fact that treatment type and hormone receptor status were not significantly associated with time of port removal. We found that 43% of patients still have their port in place one year after completing treatment and almost 19% of patients have their port in place greater than two years after completing treatment. The high cost and the possible psychological impact of leaving a port in place for long periods of time needs further study.
Enhancing patient-health care provider (HCP) communication in oncology care in the United States.
Authors: Lane Suzanne , Szabo Shelagh , Halbert Ron , Goertz Hans-Peter , Lai Catherine , Parikh Aparna , Bunce Mikele , Khoury Raya , Small Art , Masaquel Anthony 
Published: February 2017

99 Background: Patient engagement is essential for high-quality care. This study aimed to develop novel communication tools to be used between patients and HCPs to address current gaps in cancer care. Methods: Qualitative interviews were conducted with 16 US patients with various cancers and stage, 6 oncology nurses, and 4 oncologists. Goals were to understand: patients’ changing concerns at diagnosis and during treatment; HCPs views on eliciting patient preferences; and perspectives from both on improving care. A thematic analysis was conducted to identify gaps in care. 8 patients rated their experience and importance of quality care items on a scale of 1 (not experienced/not important) to 5 (experienced/very important). Two draft tools were developed to address identified gaps. Results: None of the 16 patients reported using a communication tool before or during treatment. Gaps in quality care were identified, including communication, patient-centered care, education, and comprehensive care. Communication and patient-centered care items important to patients, but not always experienced, included clearly explained treatment options, time to discuss topics of concern, patient-led decision making, an open-minded care team, and the ability to change one’s mind (mean experience ≤ 4). The first tool assesses patient’s life and treatment goals and establishes early expectations through an open-ended questionnaire. This tool aims to enrich communication between patients and HCPs, enabling more patient-centered care. The second tool addresses the importance of ongoing education using a checklist. Treatment outcomes and the impact of treatment on QOL were identified as the two most important education items for patients when making treatment decisions (mean importance = 5). This tool aims to enhance educational discussions and enable patients to specify where more information is desired. Conclusions: Patients reported a need for communication tools at the beginning of treatment, specifically related to patient goals and educational needs. With patient and HCP input, two novel communication tools were developed to improve quality care. Future studies will validate and implement the tools in clinical practice.
Enhancing the care of cancer patients with ureteral strictures managed with percutaneous nephrostomy tubes.
Authors: Sabir Sharjeel H , Patel Rakhi , Lin Brenda , Ahrar Judy , Tam Alda , Ahrar Kamran 
Published: February 2017

e264 Background: Ureteral strictures resulting from either active disease or the sequelae of cancer therapy are often managed with percutaneous nephrostomy (PCN) tubes. PCN tubes divert urine from the kidney into drainage bags, which are cumbersome to care for and potential sources of infection. In contrast, percutaneous nephroureteral (PCNU) tubes by allowing internal drainage can preclude the need for a urine drainage bag. Our goal was to implement a coordinated care program in interventional radiology (IR) designed to increase the number of patients whose PCN tubes were converted to PCNU tubes, thus preventing the long-term problems associated with urine drainage bags. Methods: An IRB approved retrospective review of all PCN tubes placed in IR from 2011-2013 was undertaken to get baseline statistics. After review of this data, a prospective care coordination program was implemented in which patients without contraindications for conversion to PCNU tubes had an attempt at conversion during their planned 3 month PCN tube exchange. The baseline and 1 year follow up data were collected. A Fisher’s exact test was used to calculate the significance of the intervention. Results: Our baseline data demonstrated on average 9% of PCN placements per year were being converted to PCNU tubes. After implementation of the prospective care coordination program from 7/2014 to 7/2015, 257 patients had PCN tubes placed. 217 patients had completed 3 month follow up at time of analysis. Of these, 30 (14%) patients had an attempt at PCNU placement because of the prospective program. Among these patients 19/30 (63%) had a successful PCNU placement. 20 (9%) patients had PCNU placement at the request of referring physicians. Overall, 39 (18%) patients had a PCNU tube placed after implementation of the program. 2/39 patients had difficulties with their PCNU tubes requiring return to PCN tubes. Conclusions: An active coordinated care program in IR aimed at preventing the long-term problems associated with PCN tubes and urinary drainage bags can increase the percentage of patients who receive PCNU tubes from 9% to 18% (p = 0.002).
Changes in demographic characteristics and motives for becoming a hospice/palliative care volunteer: Results of single institution 9 years educational program.
Authors: Wojtacki Janusz , Paczkowska Agnieszka , Majkowicz Mikolaj , Cieśnik Anna , Gurgul Natalia , Slomska Ewelina , Szczeluszczenko Aneta 
Published: February 2017

e265 Background: Voluntary activities are essential in many different aspects of hospice and palliative care. The interest in becoming a volunteer lowers in many communities. Better knowledge of volunteers’ characteristics and wider understanding of their motivations seem to be crucial for more sufficient volunteers’ recruitment and retain. Methods: Self-reported demographic details and data on motives for hospice / palliative care volunteering were collected from initial questionnaire forms fulfilled by all consecutive participants of the teaching course for medical voluntary cancer patients caregivers (16 editions; April-2006-November-2014; no data for 2009) at Rev. Eugeniusz Dutkiewicz Hospice SAC, Gdańsk, Poland. Results: all 562 records were analyzed: 1) mean volunteers age was 35,73+14,69 years and significant trend (p < 0.001) for increasing age was observed (e.g.: mean age values + SD were: 2007: 28.41+11.82; 2011: 37.19+14.93; 2014: 41.31+12.16); 2) the vast majority of volunteers were females (82.03%), who already completed education; 3) 67 of study participants declared professional connections with medicine (19.47%), 42 (12.21%) - pedagogy or 38 (11.05%) – psychology; 4) 241 (42.88%) volunteers declared full current professional activity, 174 (30.96%) were unemployed, 50 (8.89%) - retired; 5) participants mostly reported motives for volunteering which might be categorized as altruistic (67.08%: “I want to help others”) – the percentage increased significantly during the study period (p < 0.012); 6) the next two most frequently indicated motives represented category of personal gain (29.36%: “I want to improve my skills”; 26.87%: “volunteering is the way of my personal development” – not significant trend for time). Conclusions: 1) Results showed that some demographic features as well motives for hospice / palliative care volunteering changed over the time in our community - it warrants some individualization in recruitment process recognition for volunteers coordinators; 2) the study will continue to identify the volunteers’ subgroup with the greatest probability to retain at service for longer period of time.
Assessment of adequacy of pain management in advance cancer patients.
Authors: Singh Harminder , Banipal Raja 
Published: February 2017

e283 Background: Cancer prevalence in India is estimated around 2.0-2.5 million, 0.7- 0.8 million new cases identified every year, and cancer deaths reported per year is 0.4-0.5 Million. The objective of this study was to estimation of the prevalence of inadequate cancer pain management in patients with advanced cancer. Methods: Adequacy of pain management, that is Pain Management Index calculated for each patient. It is simple indexes which usually indicate a connection of the reported level of pain to the potency of the analgesics prescribed Results: 211 patients were recruited with most prevalent cancer type was genitourinary, diagnosed in 28.7% patients, followed by breast cancer 23.1% and head & neck cancer 20.3%. Among 211 patients with cancer, 76.85% patients had inadequate pain management and 23.14% had better control of pain. Association of inadequacy of pain were done with age, gender, occupation, family history, duration and cancer types, signification relation was observed with age group and analgesic use. (See table.) Conclusions: Our inadequate pain management prevalence rate of about 78% was far too high so this study will highlight the importance of true status of cancer pain management. It also emphasized that systematic recording of pain intensity and follow up further enhance the entire pain management mechanism including dose titration to change of new formulation. [Table: see text]
Second-line chemotherapy with paclitaxel for elderly patients with advanced gastric cancer.
Authors: Ohba Akihiro , Takashima Atsuo , Nishiuchi Takamasa , Honma Yoshitaka , Iwasa Satoru , Okita Natsuko , Kato Ken , Hamaguchi Tetsuya , Nagashima Kengo , Boku Narikazu 
Published: February 2017

108 Background: Survival benefits of second-line chemotherapy such as weekly paclitaxel (wPTX) for patients with advanced gastric cancer (AGC) were shown in several phase 3 trials. However, these trials included a small proportion of elderly patients, and few elderly patients receive second-line therapy in clinical practice. The aim of this study was to compare the efficacy and safety of second-line chemotherapy with wPTX between elderly and non-elderly patients. Methods: The subjects of this retrospective study were AGC patients who received wPTX as second-line chemotherapy between January 2002 and August 2014, fulfilling the following selection criteria; 1) pathologically proven metastatic or recurrent gastric adenocarcinoma, 2) receipt of wPTX after platinum or fluoropyrimidine containing chemotherapy. Patients were divided into two groups by age: ≥ 75 years old (elderly group) and < 75 years old (non-elderly group). Response rate (RR) in patients with measurable lesions, overall survival (OS), progression-free survival (PFS), post-progression survival (PPS) and adverse events were evaluated. Hazard ratios of survival were adjusted by prognostic factors using Cox proportional hazard model. Results: A total of 272 patients, 31 elderly and 241 non-elderly, were selected in this study. RRs were 6.2% (1/16) in the elderly group and 12.7% (15/118) in the non-elderly group (p = 0.69). While PFS was similar between two groups (median 2.4 vs. 3.6 months, adjusted hazard ratio [HR] 1.18, p = 0.46), the elderly group showed shorter OS than the non-elderly group (median 5.1 vs. 6.1 months, adjusted HR 1.49, p = 0.06), associated with relatively shorter PPS (median 2.2 vs. 2.6 months, adjusted HR 1.40, p = 0.11). There were no remarkable differences in the incidences of grade 3 or higher adverse events between the two groups (hematologic 38.7 vs. 41.1%; non-hematologic 25.8 vs. 23.7%). No treatment related deaths were observed in either group. Third-line chemotherapy was administered in 19.4% of elderly group and 35.3% of non-elderly group (p = 0.11). Conclusions: It is suggested that second-line chemotherapy with wPTX for AGC may be tolerable and have some clinical benefits for elderly patients as well as for non-elderly patients.
Efficacy and safety of irinotecan monotherapy as third line treatment for advanced gastric cancer.
Authors: Kawakami Takeshi , Machida Nozomu , Kawahira Masahiro , Kawai Sadayuki , Kito Yosuke , Yoshida Yukio , Hamauchi Satoshi , Tsushima Takahiro , Todaka Akiko , Yamazaki Kentaro , Yokota Tomoya , Fukutomi Akira , Onozawa Yusuke , Yasui Hirofumi ,   ASCO-GI Author's Group
Published: February 2017

113 Background: Several randomized trials demonstrated the survival benefit in advanced gastric cancer patients (AGC pts) receiving irinotecan or taxanes as second-line chemotherapy (SLC). Taxanes are used for SLC in daily clinical practice in Japan because of its less toxicity, especially in AGC pts with peritoneal dissemination, compared with irinotecan. Although irinotecan is often administered after refractory or intolerant to taxanes as SLC, the efficacy and safety of irinotecan as third-line chemotherapy (TLC) is still unclear. Methods: We retrospectively investigated the data of AGC pts administered irinotecan 150mg/m2 as TLC every two weeks until disease progression, unacceptable toxicity, or pts’ refusal between December 2002 and June 2015. Inclusion criteria were (1) age 75 years or less (2) refractory or intolerant to fluoropyrimidine with or without platinum as first-line chemotherapy (3) refractory or intolerant to taxanes as SLC. Results: A total of 52 pts were analyzed. Pts’ characteristics were as follows: median age, 66 (range, 33-75) years; male/female, 35/17 pts; ECOG PS 0-1/2, 42/10 pts; peritoneal dissemination +/-, 32/20 pts; ascites +/-, 22/30 pts, number of metastatic sites 1-2/3-4, 44/8 pts. Median follow-up period was 548 (141-1931) days. Median progression-free survival was 70 days (95%CI 49-137) and median overall survival was 144 days (95%CI 120-231) from the initiation of irinotecan administration. Response rate and disease control rate was 10.8% and 50.4%, respectively. Relative dose intensity was 74.7% (56 mg/m2/week); 14 pts needed dose reduction in the first course, and 22 pts after the second course. Grade 3 or 4 neutropenia, anemia, diarrhea, nausea, and febrile neutropenia were observed in 13 (25%), 21 (40.4%), 5 (9.6%), 3 (5.8%) and 3 (5.8%) pts, respectively. No treatment-related death was observed. Conclusions: This study suggests that irinotecan monotherapy as TLC has acceptable anti-tumor effect and has manageable toxicity in appropriately selected AGC pts.
Survival outcome of metastatic adenocarcinoma of esophagogastric junction in the trastuzumab era.
Authors: Narita Yukiya , Hasegawa Hiroko , Komori Azusa , Mitani Seiichiro , Masuishi Toshiki , Taniguchi Hiroya , Kadowaki Shigenori , Ura Takashi , Ando Masashi , Ito Seiji , Yatabe Yasushi , Tajika Masahiro , Muro Kei 
Published: February 2017

117 Background: Previous studies have reported no differences in treatment outcomes between metastatic adenocarcinoma esophagogastric junction (AEGJ) and gastric adenocarcinoma (GAC). However, after the approval of trastuzumab (Tmab) for the treatment of metastatic AEGJ and GAC survival outcomes remain unclear. Methods: We retrospectively reviewed clinicopathological characteristics, treatment outcomes, and prognoses of 289 consecutive patients with AEGJ and GAC who received ﬁrst-line chemotherapy from March 2011, when Tmab was approved in Japan, to December 2013 at Aichi Cancer Center Hospital. Prognostic factors were identified using Cox multivariate regression analysis. IHC3+ or IHC2+/ISH+ tumors were defined as HER2 positive. Results: Of 289 patients, 45 (16%) had AEGJ. Patients with AEGJ were signiﬁcantly younger with lesser lung metastases than those with GAC. HER2-positive rates in AEGJ tended to be greater than those in GAC, but this difference was not statistically significant (22% vs. 16%; P = 0.35). The rates of platinum doublet therapies were not significantly different (72% vs. 78%; P = 0.47). The objective response rate (ORR) was 27% with AEGJ and 40% with GAC (P = 0.17). The median follow-up duration was 12.1 and 11.9 months, respectively. Progression-free survival was similar for both the groups [hazard ration (HR) = 0.97; P = 0.83), while the median overall survival (OS) period was numerically longer for AEGJ than that for GC (14.7 vs. 12.4 months; HR = 0.99; 95% confidence interval = 0.69–1.39; P = 0.92). In patients with AEGJ, an ECOG performance status of 2 and HER2 negativity were signiﬁcantly associated with poor prognosis, as estimated by the multivariate analyses of OS. The analyses that were limited to patients treated with Tmab as the first-line chemotherapy revealed no significant differences in ORR and median OS between AEGJ and GAC. Conclusions: Even in the Tmab era, there were no significant differences in survival outcomes between metastatic EGC and GAC.
The examination of appropriate surveillance after resection of GIST from 115 recurrent patients.
Authors: Wada Noriko , Takahashi Tsuyoshi , Masuzawa Toru , Kawata Junji , Nishida Toshirou , Kurokawa Yukinori , Nakajima Kiyokazu , Miyazaki Yasuhiro , Makino Tomoki , Yamasaki Makoto , Takiguchi Shuji , Mori Masaki , Doki Yuichiro 
Published: February 2017

12 Background: Previous studies have proposed some risk classifications and contributed to the prediction of the prognosis in gastrointestinal stromal tumor (GIST) patients after resection. However, optimal postoperative surveillance has not been established yet. We investigated the characteristics of GIST patients who developed recurrence after resection to establish optimal postoperative surveillance for recurrence. Methods: Between July 1978 and November 2014, 115 patients developed recurrence after macroscopically complete resection for primary GIST. We investigated the clinicopathological factors, time to recurrence (TTR) and first recurrence sites to determine the optimal duration and methods of surveillance. We also compared the characteristics between the two subgroups with TTR ≤ 5 years or > 5 years. Results: The median age was 60 (15-84) years old and 62% of the patients were men. The most common primary tumor site was the stomach (39%), followed by the small intestine (37%), duodenum (11%), large intestine (10%) and esophagus (2%). The median tumor size was 8.5 (1.5-30.0) cm and the median mitotic count was 4 (0-165) /50 HPF. The site of recurrence was liver (57%), followed by peritoneum (48%), local (21%), bone (4%) and lymph node (2%). Almost all patients, except one lung recurrence by esophageal GIST, showed primarily recurrence in the abdominal site. The median period of recurrence after resection 21 (1-172) months and 12% of the recurrence occurred over 5 years. We divided the two groups by the period of recurrence, Early-group (E) ( ≤ 5 years), and Late-group (L) ( > 5 years). Comparing the two groups, E group showed a smaller size (median, 3.5 vs. 9.0 cm) (p < 0.001) and a lower risk classification (p < 0.001) than L group. Although liver recurrence was the most frequent in E group (60 %), local recurrence was the most frequent in L group (43 %). Conclusions: Twelve percent of the recurrence occurred over 5 years, and almost all patients showed primarily recurrence within the abdomen. This may indicate that postoperative surveillance after complete resection for primary GIST is recommended over 5 years by abdominal examination.