bluuebunny/crossref_metadata_2025_split huggingface dataset:
Perceived competency and knowledge in palliative and end-of-life care among physicians at an academic institution.
Authors: Sanchez Larysa Jessica , Duma Narjust , Jaker Michael , Wong Kristin 
Published: February 2017

59 Background: Given the importance of palliative and end-of-life (EOL) care in terminally ill patients (pts), it is crucial that physicians feel comfortable in leading EOL discussions and possess adequate knowledge in palliative care skills. Methods: We conducted an online survey of physicians at our institution to evaluate competency and knowledge in palliative and EOL care. The survey consisted of 39 questions in self-assessed skills and a 26-question validated knowledge test. Results: There were a total of 70 respondents across specialties: 30% internal or family medicine, 24.3% surgery, 14.3% pediatrics, 31.4% other, 5.7% medical/surgical oncology. The median (M) age was 52.5 (33-99), 64% were male. 18.6% reported caring for 1 to 2 dying pts and 35.7% for 3 to 10 or more dying pts in the previous 3 months (mos). 45.7% had 1 or more EOL discussions in the previous 3 mos. There was no association between (btw) the number of dying pts cared for and the number of EOL discussions, p < 0.89. 31.4% felt comfortable and 15.7% felt very comfortable providing palliative/EOL care, while 18.6% felt very uncomfortable or uncomfortable and the plurality, 34.3%, felt neither comfortable nor uncomfortable. Physicians who were comfortable or very comfortable were 1.63 times more likely to have 2 or more EOL discussions in the previous 3 mos, p < 0.0001. When rating competency level in various skills, 80% reported average (avg) to above avg skill in pain assessment, 58.6% below avg to avg in opioid dosing, 64.3% below avg to avg in managing opioid side effects, 65.7% avg to above avg in assessing non-pain symptoms. The M score on the knowledge test was 69.2 (46.1-88.4) % correct, with most incorrect answers in managing cancer pain. There was no correlation btw test score and overall comfort level, p < 1.567. Conclusions: In our cohort, the plurality of respondents felt neither comfortable nor uncomfortable in providing palliative and EOL care, self-assessed competency was often rated as below avg or avg, and overall comfort level did not correlate with knowledge test scores. This study highlights the need to improve continuing medical education in palliative and EOL care in order to enhance the quality of care physicians provide to pts.
Engaging patients and stakeholders in the process of designing a clinical trial and patient education platform.
Authors: Rosati Lauren M. , Douglas Sarah , Leventer Roger , Singer Sievers Laurie , Swan Randall W. , Teesdale James L. , McKnight Andrew D. , Engebretson Anitra , Elnahal Shereef , Hacker-Prietz Amy , Badri Omar , Yang Adeel , Al-Sulaihim Nasser M. , Pawlik Timothy M. , Browner Ilene S. , Laheru Dan , Erdek Michael A. , Snyder Claire F. , Smith Thomas J. , Herman Joseph M. 
Published: February 2017

63 Background: Patient engagement during the initiation, development, and implementation of a study has been shown to improve the ethical nature of research and the appropriateness of treatment methods, and insights into how best to partner with patients are needed. We describe our patient engagement experience in developing a clinical trial for non-metastatic pancreatic cancer (PCA). Methods: A team of patient research partners (PRPs) was consulted to design a multi-institutional study to evaluate the efficacy of chemotherapy, stereotactic body radiation therapy, and early palliative care (EPC) in patients with PCA who are typically ineligible for clinical trials due to advanced age, poor performance status, or preexisting comorbidities. PRPs included patients, caregivers, clinical researchers, patient advocacy organizations, and pharmaceutical companies. A 22-item initial survey on personal interests and a 5-item follow-up survey on study design were anonymously completed after two in-person meetings. Results: Of 15 PRPs involved, 9 completed the initial survey and 10 completed the follow-up survey. PRPs were most interested in improving quality of life (QOL, 89%), care coordination (78%), symptom management (67%), stress/anxiety (56%), and survival (56%). Confidence in the care team, hope, QOL, education and understanding, dignity, and pain management were reported to be the most important factors throughout the cancer experience. The majority (89%) requested that study participants have access to the study protocol and research publications supporting the study design. Because all PRPs suggested that a personal website be used to provide information to study participants and to disseminate the results of the study, an online patient education platform was adopted and customized for patients (and caregivers). Furthermore, integration of EPC into the treatment regimen was unanimously endorsed. Conclusions: Engaging PRPs in the process of designing a clinical trial for PCA appears to be feasible and valuable in identifying the study objectives most important to patients. PRPs conveyed that maintaining a good QOL is essential, and adoption of EPC in these patients should be considered.
Pilot study assessing distressors affecting patients with cancer using the distress screening tool.
Authors: Finianos Antoine Nafez , Aragon-Ching Jeanny B. , El Bahesh Ehab , Amdur Richard , Bires Jenifer , Guebre-Xabiher Hiwot 
Published: February 2017

68 Background: Distress is a non-stigmatic description of emotional, physical, spiritual or psychiatric stressors experienced by patients (pts) diagnosed with cancer. We sought to determine the prevalence of distress in different cancer population of pts seen in our cancer center as they are commencing chemotherapy. Methods: We retrospectively examined data using the Distress Thermometer (DT) based on the National Comprehensive Cancer Network (NCCN) and assessed a single encounter on 240 consecutive patients undergoing their first chemotherapy session. Univariate associations were examined between specific problems and overall distress levels with a 2-tailed between-group t-test. Problem area scores were computed for each subject by taking the mean number of problems rated positive within each area, and associations between each problem area score and distress was examined using Spearman correlations. Results: Among the 240 patients in the sample, mean age was 60 ± 14, 61% were female, and 82% had solid tumors. The overall mean distress, based on the DT reading, was 3.6 ± 3.0. Specific problems reported by the largest number of patients included worry (n = 85), nervousness (n = 79), fatigue (n = 70), sleep (n = 66), and fears (n = 57). Of these, all but fatigue were significantly associated with global distress in univariate analysis. When mean problems per area were calculated, and correlated with global distress, each problem area (practical, emotional, family, physical) had a significant univariate association with global distress, with emotional problems having the highest correlation (r = .52, p < .0001). The only predictors with significant independent associations to predict global distress in the general linear model were emotional problems (p = .0001) and family problems (p = .0062), independent of age, sex and tumor types. Conclusions: In cancer patients undergoing distress screening as they receive their first chemotherapy, emotional and family problems appear to have the highest correlation with distress. Improvement of supportive care services geared towards the betterment of these symptoms is of paramount importance in improving outcomes.
From PRO screening to improved wellness: A nurse-led intervention.
Authors: Morris Alison , Tribett Erika L , Tun Sandy , Winget Marcy , Blayney Douglas W. , Ramchandran Kavitha 
Published: February 2017

72 Background: Emotional and physical distress in cancer patients is underreported and undertreated. In effort to address this, the Quality Oncology Practice Initiative (QOPI) requires patients to be screened for emotional well-being and pain by their second oncology visit. This project details one cancer center’s quality improvement initiative to: (1) utilize patient reported outcomes (PRO) screening to identify patient distress, (2) develop adaptive nurse-led algorithms to assess and intervene for unmet needs. Methods: In June 2015, we launched electronic collection of PROs using the Patient Reported Outcome Measurement Instrument System (PROMIS) global screen. Screening is completed via EMR patient portal prior to first return visit and 30-day intervals thereafter. A nurse-led algorithm categorizing distress was developed with evidence-based clinical pathways for care. Pathways optimize primary palliative care and referrals to specialist palliative services when appropriate. In August 2015, we will randomize four nurse navigators in gynecologic oncology to test the algorithm and make adaptations for scaling cancer center wide. We will assess the percent of patients screening positive for distress and the rate of primary palliative care interventions (e.g., symptom management and psychosocial support). We will also assess rate of referral to specialist palliative teams. Finally, we will interview a subset of patients to compare self-reported need, clinical management of needs, and whether needs were managed to the patient’s satisfaction. Results: We expect to report on adoption and adaptation of the algorithm for disease-specific groups. We will also report rates of primary palliative care interventions, referrals to specialist palliative care and PROs. Conclusions: Standard screening using PROs and clinical care pathways may foster early identification and management of patient’s psychosocial and physical needs. Support for oncology nurses to lead assessment and connect patients with resources is an opportunity to incorporate primary palliative care into oncology practice. The use of structured, adaptive, novel algorithms is a promising approach to meet patient needs and improve access to supportive resources.
Health plan, physician, and medical care ratings among end-of-life (EOL) cancer survivors.
Authors: Halpern Michael T. , Urato Matthew , Schwartz Margot , Kent Erin E. 
Published: February 2017

80 Background: High-quality EOL care is critical for patients and families. However, little is known about factors influencing patient satisfaction with their healthcare near EOL. This study’s objective is to assess the role of characteristics of individuals with cancer near EOL on their ratings for medical care, health plans, and physicians. Methods: Retrospective analyses of the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Medicare Survey linked to NCI’s Surveillance, Epidemiology, and End Results (SEER) Program. CAHPS collected Medicare beneficiaries’ ratings for overall care, physicians, health plans, and 5 composite scores of aspects of care; SEER provided data on cancer diagnosis and characteristics. The study included 5,102 Medicare beneficiaries diagnosed with cancer in SEER regions 1997-2011 who completed CAHPS following diagnosis and within one year before death. Logistic regression was used to examine associations of EOL patient characteristics with their ratings. Results: Self-reported very good or excellent (vs. poor) general health significantly (p < 0.05) predicted greater likelihood of higher ratings for all measures (ORs ranged 1.5 to 2.2). Very good/excellent mental health also predicted increased likelihood of higher ratings for all except one category (ORs 1.8 to 2.7). Other patient factors were significantly associated with a subset of ratings. For example, Hispanics (vs. Whites) were more likely to provide higher ratings for health plans (OR 1.5) and specialist physicians (OR 1.7) but lower ratings for getting needed care (OR 0.62). Fee-for-service (vs. Medicare Advantage) beneficiaries were more likely to provide higher ratings for health plans, getting needed care, and getting care quickly (ORs 1.4, 1.3, 1.6). Patient age, cancer site, and time since diagnosis had few or no significant associations with any measure. Conclusions: Among cancer patients near EOL, better self-reported general and mental health consistently predicted higher ratings. Fee-for-service Medicare patients provided higher ratings for several important categories. These results may help guide future research on interventions to improve the EOL experience among Medicare beneficiaries.
Patient and caregiver well-being: Observation of changing dyad over time.
Authors: Sannes Timothy S , Mikulich-Gilbertson Susan K , Simoneau Teresa L , Laudenslager Mark L 
Published: February 2017

89 Background: Allogeneic hematopoietic stem cell transplant (Allo-HSCT) is a particularly stressful time for patient and caregivers alike. As such, well-being within patient-caregivers dyads is highly correlated in previous studies. It is less clear how this dyadic relationship changes over the course of treatment and recovery. Methods: In these secondary analyses of a randomized clinical trial of psychoeducational support (5 time points across 12 months), partial correlations, adjusting for group assignment and age, tested the relationship between individual mental and physical summary scores of patients and caregivers. 117 Allo-HSCT patient and caregivers provided baseline data, with available data used at each subsequent timepoint. Quality of life was measured with the Short-Form Health Survey; divided into mental (MCS) and physical summary (PCS) scores. Results: Patients were primarily men (69.6% male; Mage=49.36; SD=13.04); caregivers were primarily female (78%;Mage=53.26;SD=12.34). Patient and caregivers’ MCS were significantly correlated at baseline (r=.23;p<.05) and 4 weeks after consenting to study participation, (r=.26;p<.01), whereas patients’ PCS scores were significantly correlated with caregivers’ MCS at 3 months (r=.26;p<.05). At 6 months, the relationship between patient PCS and caregiver MCS was no longer significant (p=.51), whereas the relationship between patient and caregiver MCS re-emerged at 6 months (r=.32; p<.05). In evaluating 6 month completers (N=84), the trend between patient-caregivers well-being displayed the same significant pattern at each timepoint. Conclusions: These data replicate significant relationships of mental well-being within patient-caregiver dyads in Allo-HSCT. This relationship shifts over time, in which caregiver mental well-being becomes related to patients’ physical functioning. These data underscore the importance of this dyadic relationship and deserve follow-up statistical approaches (e.g., covariation). Extending these relationships to clinical endpoints remains an area for future investigation. Funding: NIHCA126971(MLL); T32AG044296(TS): DA034604(SMG) and PCORI CE-1304-6208(MLL). Clinical trial information: NCT00833898.
An updated overall survival analysis with correction for protocol-planned crossover of the international, phase III, randomized, placebo-controlled trial of regorafenib in advanced gastrointestinal stromal tumors after failure of imatinib and sunitinib (GRID).
Authors: Demetri George D. , Reichardt Peter , Kang Yoon-Koo , Blay Jean-Yves , Joensuu Heikki , Schaefer Klaus Bernd , Kuss Iris , Kappeler Christian , Casali Paolo Giovanni 
Published: February 2017

110 Background: The GRID study showed that regorafenib improves progression-free survival compared with placebo in patients with advanced GIST after failure of at least imatinib and sunitinib (HR 0.27; 1-sided p<0.0001; Demetri 2013). At the time of the primary analysis, no significant difference in the secondary endpoint of overall survival (OS) was observed (HR 0.77; p=0.199), but this result may have been confounded by the high rate of crossover to regorafenib (85%) of placebo patients at progression. We conducted exploratory analyses of updated OS data to assess the effect of correcting for this protocol-planned crossover. Methods: The data cut-off for this updated OS analysis was 31 January 2014 (2 years after the primary analysis). OS was corrected using two randomization-based methods: rank preserving structural failure time (RPSFT) and iterative parameter estimation (IPE); both methods are considered as best choice among all correction analytics. Hazard ratios and 95% CI were derived using the Cox model. Results: A total of 139 deaths had occurred at the time of data cut-off: 91 events (68.4% of patients) in the regorafenib group and 48 (72.7%) in the placebo group. A total of 22 patients remained on regorafenib treatment (median duration 2.1 years, range 0.9–2.4). The updated hazard ratio for OS favored regorafenib (0.85, 95% CI: 0.60 - 1.21; p=0.18). Median OS was estimated as 17.4 months in both groups, with crossover from placebo. The corrected HRs for OS are less than the uncorrected HR (Table). Conclusions: The updated analysis of OS in the GRID trial is consistent with the primary analysis. An exploratory analysis correcting for the impact of cross-over on OS suggests a survival benefit for regorafenib in GIST. Clinical trial information: NCT01271712. [Table: see text]
Optimal extent of lymphadenectomy in gastric adenocarcinoma: A seven-institution study of the U.S. Gastric Cancer Collaborative.
Authors: Randle Reese W. , Swords Doug S. , Levine Edward Allen , Fitzgerald Nora , Squires Malcolm Hart , Poultsides George A. , Fields Ryan C. , Bloomston Mark , Weber Sharon M. , Pawlik Timothy M. , Jin Linda X. , Spolverato Gaya , Winslow Emily , Schmidt Carl Richard , Kooby David A. , Worhunsky David J. , Saunders Neil , Cho Clifford Suhyun , Maithel Shishir Kumar , Votanopoulos Konstantinos Ioannis 
Published: February 2017

115 Background: The optimal extent of lymphadenectomy in the treatment of gastric adenocarcinoma continues to be a subject of intense debate. We aimed to compare gastrectomy outcomes following limited (D1) or extended (D2) lymphadenectomy. Methods: Using the multi-institutional U.S. Gastric Cancer Collaborative database, we reviewed the morbidity, mortality, recurrence, and overall survival (OS) of 727 patients receiving D1 or D2 lymphadenectomies. Patients with stage IV disease, prior gastrectomy, and age 85 or greater were excluded. Multivariate analyses included variables with p values less than 0.1. Results: Between 2000 and 2014, 266 (36.6%) and 461 (63.4%) patients received a D1 and D2 lymphadenectomy, respectively. ASA class, mean number of comorbidities, grade, stage, and signet ring cell subtypes were similar between groups. Neoadjuvant and adjuvant chemotherapy was more common in the D2 group (p<0.001). The mean number of lymph nodes recovered was significantly higher in patients receiving a D2 lymphadenectomy (21.5 for D2 vs. 17.1 for D1, p<0.001). Median follow up was 1.3 years. While Clavien III/IV major morbidity was similar (15.0% for D1 vs. 14.5% for D2, p=0.85), mortality was worse for those receiving a D1 lymphadenectomy (4.9% vs. 1.3%, p=0.004). Recurrence rates for patients receiving D1 and D2 lymphadenectomies were 25.8% and 27.0%, respectively (p=0.74). D2 lymphadenectomy was associated with improved median OS in stage I (4.7 years for D1 vs. not reached for D2, p=0.003) stage II (3.6 years for D1 vs. 6.3 for D2, p=0.42), and stage III patients (1.3 years for D1 vs. 2.1 for D2, p=0.01). After adjusting for significant predictors of OS which included ASA, stage, grade, neoadjuvant chemotherapy, and adjuvant radiation, D2 lymphadenectomy remained a significant predictor of improved survival when compared with D1 lymphadenectomy (HR 1.5, 95% CI 1.1-2.0, p=0.008). Conclusions: D2 lymphadenectomy is associated with improved survival that is more prominent in early stages of disease. It can be performed safely without increased risk of morbidity and perioperative mortality and should be the preferred lymphadenectomy technique for the treatment of gastric adenocarcinoma.
Impact of radiotherapy duration on outcomes in patients with esophageal cancer treated with definitive concurrent radiotherapy and chemotherapy on RTOG trials 8501 and 9405.
Authors: Hallemeier Christopher Leigh , Moughan Jennifer , Haddock Michael G. , Herskovic Arnold M. , Minsky Bruce D. , Kim Harold , Major Pierre , Gore Elizabeth , Schnall Mitchell D. , Zeitzer Kenneth Lee , Komaki Ritsuko , Bush David , Jacob Rojymon , Garg Madhur , Crane Christopher H. 
Published: February 2017

119 Background: Radiotherapy (RT) interruptions have a negative impact on outcomes in many epithelial malignancies treated with definitive RT. The purpose of this study was to analyze the impact of RT duration on outcomes in patients (pts) with esophageal cancer treated with definitive chemoradiotherapy (CRT). Methods: Pts treated with definitive CRT on RTOG trials 8501 and 9405 were included. Separate analyses were performed in pts receiving standard dose (SD-CRT; 50 Gy + 5FU + cisplatin) and high dose (HD-CRT; 64.8 Gy + 5FU + cisplatin) CRT. Local (LF) and regional (RF) failure were estimated by the cumulative incidence method. Disease-free (DFS) and overall (OS) survival were estimated by the Kaplan-Meier method. Univariate (UVA) and multivariate (MVA) Cox proportional hazards models were utilized to examine for correlation between RT duration (< vs. ≥ median) with LF, RF, DFS and OS. Results: In the SD-CRT cohort (n=235), 96 pts (41%) had ≥ 1 RT interruption for a median of 3 (IQR 1-6) days. The median RT duration was 39 (IQR 37-43) days. In UVA and MVA, RT duration was not associated with LF, RF, DFS, or OS. Estimated outcome rates are in the table. In the HD-CRT cohort (n=107), 64 pts (60%) had ≥ 1 RT interruption for a median of 3.5 (IQR 2-7.5) days. The median RT duration was 52 (IQR 50-57) days. In UVA, RT duration ≥ 52 days was associated with a 33% reduction in risk of DFS failure (HR=0.66, 95% CI [0.44-0.98], p=0.039) and a 29% reduction in risk of death (HR=0.71, 95% CI [0.48-1.06], p=0.09). When excluding the 25 pts with RT dose < 64.8 Gy, RT duration was not associated with DFS or OS. Conclusions: In pts with esophageal cancer receiving definitive SD-CRT, an association between RT duration and outcomes was not observed. In pts receiving HD-CRT, longer RT duration was associated with improved DFS, which may have been due to a significant number of deaths at RT dose < 64.8 Gy. Supported by NCI U10 grants CA21661, CA180868, CA180822, CA37422. Clinical trial information: NCT00002631. [Table: see text]