bluuebunny/crossref_metadata_2025_split huggingface dataset:
Early radiation response between GnRH agonist versus antagonist combined with radiotherapy in high-risk prostate cancer.
Authors: Crehange Gilles , Cochet Alexandre , Cueff Adele , Martin Etienne , Maingon Philippe , Brunotte Francois , Walker Paul M 
Published: February 2017

97 Background: Degarelix, a GnRH antagonist, provides a very rapid and sustained testosterone suppression alongside with the VEGF pathway inhibition through the FSH receptors. This raises the question as to whether high risk localized prostate cancer (HRPCa) could respond differently to radiotherapy (RT) + Degarelix when compared with RT + GnRH agonist. Methods: 30 HRPCa patients were treated with exclusive RT combined with a GnRH agonist (n= 19) or Degarelix (n= 11). MRSI was performed before the start of hormones and 3 months after the end of RT. Choline (tumor metabolism) and citrate (healthy prostate metabolism) were quantified with MR spectroscopy and the slopes of gadolinium wash-in (SWI) and wash-out (SWO) were assessed in the peripheral zone (PZ), the central gland (CG) and the tumor with DCE-MRI. Results: At baseline, 14 patients had a T3 (46.7%) and 9 patients (30%) had a GS≥8. The median PSA values were 12.7 ng/mL [3.0-153.7] for agonists and 14.0 ng/mL [6.8-23.6] for Degarelix (p=ns). The mean prostate volumes (Pvol) were 32.0±15.5 mL for agonist and 33.0±10.0 mL for Degarelix (p=ns). The median dose of RT was 78Gy in each group, [72.0-80.0] with agonist and [70.2-80.0] with Degarelix. There were no significant differences in choline, citrate, SWI and SWO in the PZ, the CG and the tumor. At 3 months, Pvol were 20.8±8.0 mL for agonist and 21.4±6.2 mL for Degarelix (p=0.71) and the mean and median PSA values for agonist vs Degarelix were 0.5±0.8 ng/mL vs 0.1±0.1 ng/mL and 0.1 ng/mL [0.02-2.8] vs 0.1 ng/mL [0.005-0.3], respectively. Citrate was significantly decreased with Degarelix in the PZ (4.3±4.4 vs 1.1±0.8, p=0.0142), in the CG (4.0±4.0 vs 1.1±1.0, p=0.009) but not in the tumor (2.5±2.6 vs 1.7±1.9, p=0.23). Choline concentrations were similar between both groups in the PZ, the CG and the tumor. There was a trend towards a lower contrast uptake in the tumor with Degarelix (mean SWI and SWO: 134.6±56.2 s-1 vs 104.1±36.3 s-1, p=0.13 and 259.6±103.1 s-1 vs 306.1±70.4 s-1, p=0.15). Conclusions: Degarelix combined with RT offers a significant early, more profound metabolic atrophy in the prostate, but not in the tumor. There is a trend towards a lower tumor vascularization with Degarelix compared with GnRH agonists.
End-of-life care decisions using Korean advance directives among cancer patient-caregiver dyads.
Authors: Koh Su-Jin , Kim Shinmi , Kim JinShil 
Published: February 2017

11 Background: The Korean advance directives (K-ADs) consist of a value statement, treatment directives (cardiopulmonary resuscitation [CPR], preferences for artificial ventilation, tube feeding, and hospice care). K-ADs can facilitate a patient’s decision-making for end-of-life (EOL) care. This study aims to examine the extent to which patient-caregiver dyads agreed on decisions for EOL care using the K-ADs. Methods: Using a descriptive study design, 81 cancer patients were invited to participate. The final sample consisted of 44 patient-caregiver dyads who completed K-ADs; 36 (44.4%) of the initial 81 patients declined to participate. Results: Patient participants had different cancerdiagnoses: 29.5% colorectal cancer, 29.5% breast, and 15.9% liver/biliary tract cancers; 59% of the sample had advanced stage cancer. Spouse (70.5%) and adult children of the patient (20.4%) were primary caregivers with perceived bonding rated as fair (31.8%) or good (65.9%). Rejection of K-ADs was mainly because of difficulty in deciding EOL care (50%). Comfort in dying was the most common theme of the value statement for patients (73.8%) and caregivers (66.7%). For treatment directives, dyads advocated for hospice care (66.7%) and reduced support for aggressive treatments of CPR or artificial ventilation, k = .43, p = .004 and k = .28, p = .046, respectively. These approaches showed significantly mild to moderate concordance among the dyads. Sixteen out of the 21 dyads identified their spouses as a proxy, with others designating their adult children. Conclusions: The findings of the study are exploratory but suggest the need for ongoing EOL discussion where patient-caregiver dyads are encouraged to participate in the decision-making for EOL care.
Are hospital clinicians aware of legislation surrounding provision of palliative care?
Authors: Wong Aaron Kee Yee 
Published: February 2017

118 Background: Many deaths require medical treatment to be withheld or withdrawn. Patients or their substitute decision makers may disagree with these decisions, and sometimes refuse the right to appropriate palliative care. An awareness of legal frameworks surrounding end of life decisions is vital to navigate through these conflicts. Without this, patients suffer unnecessarily. Methods: 542 hospital doctors and nurses were recruited from a large metropolitan public tertiary teaching hospital network involving 5 campuses and 2 medical schools. A questionnaire examined their regarding legislation surrounding end of life care, both in adults with and without capacity. Results: Approximately a quarter of respondents did not believe that the “Not for Resuscitation Form” is legally a medical decision. Most doctors (68%), but not nurses, believed competent patients cannot demand futile treatment. Most clinicians (79% doctors and 85% nurses) erroneously believe that competent patients can refuse appropriate palliative care. There was significant confusion regarding the roles of substitute decision makers. Most clinicians could not find the advance directive. Groups with most correct answers were doctors, had 5-10 years experience, and were in palliative care and critical care specialties. Conclusions: This study confirms poor knowledge regarding legislation surrounding provision of palliative care. An unusually high proportion believed patients could refuse appropriate palliative care. Most clinicians could not locate advance directives. Most nurses believed patients could legally demand futile treatment. Both junior and senior staff had comparably poor knowledge in this area.
Using a values assessment as a bridge to advance care planning: Results of 1286 patient reports.
Authors: Hoverman John Russell , Taniguchi Cynthia , Eagye Kathryn J , Ash-Lee Susan , Kalisiak Angela , Mikan Sabrina Q. , Hartung Nicole 
Published: February 2017

12 Background: Recent studies have shown that formal Palliative Care (PC) improves care at the end of life for cancer patients. The role of communication in PC is not defined. Other studies have shown that communication alone can be associated with better end of life outcomes. The US Oncology Network developed and tested a Values Assessment (VA) instrument for routinely broaching difficult topics to facilitate more formal advance care planning (ACP). The results of the first 28 months of the program on over 1200 patients are reported here. Methods: The VA consists of 10 questions of the format “How valuable is it to me to….”, for example “know that I am not a burden to my family, friends or helpers?” Responses were on a 4 point scale from unsure to very valuable. The VA was completed either in person in the clinic or telephonically. VA participation by n = 1286 metastatic cancer patients treated at participating practices from 4/1/2013-7/31/2015 were extracted from the EHR and confirmed by chart review, as were demographic (age, gender, ethnicity), clinical (diagnosis and stage), chemotherapy treatment and outcomes (hospice enrollment and place of death). Demographics and outcomes were compared using the Chi-Squared or Fisher’s Exact Test, or Wilcoxon Rank Sums test for continuous variables. Results: 1268 patients completed the VA. 56.7% were 65 or over. 57.8% went on to complete Advance Directives (AD). 52% had colon or lung cancer. There were 438 deaths of which 431 had a date of last chemotherapy recorded. Of these 431 patients, 78% died at home or inpatient hospice, 14.6% in the hospital. Hospice enrollment with AD was 76.1%, without 60.9%. (p = .008) Median LOS in hospice was 21 days vs. 12.5 (p = .025). Chemotherapy in the last 14 days of life was 7.05% with AD, 13.4% without. The VA was well accepted by patients. Conclusions: A VA as a routine part of practice is feasible and scalable. It can be delivered successfully either face to face or telephonically. It facilitates ACP discussion leading to AD. The results suggest VA and ACP lead to less aggressive care at the end of life.
Evaluation of hematologist/oncologist attributes by physicians and patients: A survey study.
Authors: McIntyre Kaitlin , Patrick Cory , Singal Rakesh , Hansra Damien Mikael 
Published: February 2017

124 Background: We aim to compare what attributes are important to hematology/oncology (hem/onc) physicians (MD) and patients (pts). Methods: IRB approval obtained. Pts and MDs at an academic tertiary care medical center were enrolled to complete a survey. Demographics include: age, gender, race, and ethnicity. Clinical info collected: cancer subtype and treating MD. Survey consisted of 5 questions assessing opinions on physician attributes. Patients were asked: “It is important that my doctor” is friendly, is empathetic, is knowledgeable, well dressed, and engaged in research. MDs were asked: “It is important to be” friendly, empathetic, knowledgeable, well dressed, and engaged in research. Answers recorded on a 5 point scale (1 = highly disagree, 2 = disagree, 3 = neutral, 4 = agree, 5 = highly agree) & converted into 2 categories (1,2,3 = neutral/disagree vs. 4,5 = agree). Fisher’s exact test with 2 sided p-value used to compare significance between MD & pts responses. Results: 1008 pts and 55 MDs enrolled from June 2013 to October 2015. Pt mean age 55, range 18-88 with 45% male & 55% female. 62% of pts were Hispanic vs. 38% not Hispanic. 16% white, 14% black/African American, 2% Asian/Pacific Islander, & 6% other. 21% of pts had hematologic disorders (92% malignant 8% benign) vs. 79% of pts had solid malignancies. Significant difference was seen for research where 93% of pts agree that having a doctor who is engaged in research is important vs. 63% of MDs, p < 0.0001. A majority of pts and MDs agree that friendliness (92% vs. 91% resp., p = 0.6032), empathy (91% vs. 93% resp., p = 1.000), fund of knowledge (95% vs. 94% resp., p = 0.7442), being well dressed (79% vs. 69% resp., p = 0.0901), is important but no significant differences seen. Conclusions: Hem/onc pts and MD agree that friendliness, empathy, fund of knowledge, being well dressed are important attributes in a hem/onc MD. A significantly increased percentage of patients find it important that their hem/onc MD is engaged in research. It is expected that increased hem/onc MD research will not only contribute to society but also it could improve patient satisfaction.
Last year of life of cancer patients who are adolescents and young adults (AYA): Inpatient patterns and disparities in a population-based study.
Authors: Johnston Emily E. , Alvarez Elysia Marie , Saynina Olga , Sanders Lee , Bhatia Smita , Chamberlain Lisa J. 
Published: February 2017

126 Background: Cancer is the leading cause of non-accidental death among adolescents and young adults (AYA) in the US. The last year of life involves significant inpatient resources for older patients. We sought to determine the quantity and pattern of inpatient care for AYA cancer decedents in the last year of life to learn their healthcare system impact and groups to target for intervention. Methods: Using the California Office of Statewide Health Planning and Development private administrative database linked to death certificates, we performed a retrospective cross-sectional population-based analysis of patients aged 15-39 with cancer who died between 2000-2011. We calculated the number of admissions, hospital days, and percent of the cohort admitted each day in the last year of life. We determined the bed-day distribution across the population and the clinical and socio-demographic factors associated with high inpatient utilization. Results: The 9562 AYA cancer decedents were 45% non-Hispanic white, 30% Hispanic; 20% had hematologic malignancies, 70% had solid tumors. They were hospitalized, on average, 4.3 times and 40.6 days in the last year of life, increasing 3 months before death. Bed day occupation was skewed: 5% of the patients occupied 20% of the bed days and 18% occupied 50%. Factors associated with increased odds of being a top 5% utilizer were being Hispanic (OR: 1.48, 95% CI: 1.15-1.90, ref: non-Hispanic white), and having Acute Myelogenous Leukemia (AML) (2.7, 1.74-0.67, ref: Acute Lymphoblastic Leukemia (ALL). Factors associated with decreased odds were rural residence (0.39, 0.23-0.67, ref: urban), HMO insurance (0.58, 0.38-0.88, ref: private non-HMO), no hospitalizations at specialty centers (0.72, 0.53-0.97, ref: specialty center only), and having lymphoma or a solid tumor (ORs 0.035-0.39, CI range 0.005-0.56, ref: ALL). Conclusions: AYAs dying of cancer spent 40.6 days in the hospital in their last year of life (more than 1 in 9 days) with higher rates for Hispanics, AML patients, those with urban residence, and those hospitalized at specialty centers. Further research needs to determine what is driving these patterns, if they are preventable, and if they align with patient and family wishes.
The effect of early palliative care consultation for survival in patients with unresectable pancreatic cancer.
Authors: Kosugi Kazuhiro , Omata Fumio , Fujita Yoshiyuki , Hayashi Akitoshi 
Published: February 2017

131 Background: Additional early palliative care consultation (EPCC) on standard oncology care (SOC) was reported to prolong survival of patients with metastatic non–small cell lung cancer by one randomized controlled trial. However, its survival benefits for the patients with other advanced cancer have not fully been investigated yet. Pancreatic cancer is one of neoplastic diseases which seldom can be diagnosed in early stage and it is important to know the effectiveness of EPCC. The aim of this study was to determine the effectiveness of EPCC for survival of unresectable pancreatic cancer(UPC). Methods: A retrospective cohort study was conducted in tertiary referral hospital in Tokyo, Japan. 98 patients were diagnosed with UPC between Jan 2004 and February 2007. Candidate variable as predictors for survival analysis included basic characteristics of patients such as age and gender, EPCC, American Joint Committee on Cancer (AJCC) stage, Charlson comorbidity index (CCI), ECOG performance status (PS), and chemotherapy. EPCC was defined as referral to board certified palliative care physician within 30 days after initial diagnosis of UPC. Patients were classified to EPCC with SOC and SOC only group. Bivariate analyses was conducted to compare EPCC with SOC and SOC group. Kaplan-Meier estimates were calculated. Cox proportional hazard model was applied for multivariate analysis. Results: The basic characteristics of patients are described in table. Median estimates of survival [95%CI] were 64 days[21-99] in the group of EPCC with SOC, and 132 days [69-174] in the group of SOC only (P=0.0065, Log-rank test). Adjusted hazard ratio [95% CI] of AJCC stage, chemotherapy, and EPCC was 1.82 [1.02-3.49], 0.41 [0.25-0.70], 2.02 [1.03-3.70], respectively. Conclusions: EPCC may be a significantly poor prognostic factor in the patients with UPC. [Table: see text]
Patterns of intensity of end-of-life care for adolescents and young adults with cancer: A population-based study.
Authors: Johnston Emily E. , Alvarez Elysia Marie , Saynina Olga , Sanders Lee , Bhatia Smita , Chamberlain Lisa J 
Published: February 2017

132 Background: Cancer is the leading cause of non-accidental death amongst adolescents and young adults (AYA), aged 15-39, in the U.S. It is critical to understand end of life (EOL) care of AYA cancer decedents, including use of medically intense interventions like intubation. Although desired by some, most patients prefer a natural death. We sought to determine rates of medically intense interventions at end of life for AYA cancer decedents and associated factors. Methods: Using the California Office of Statewide Health Planning and Development private administrative database linked to death certificates, we performed a retrospective population based analysis of patients aged 15-39 with cancer who died between 2000-2010. We used previously defined administrative codes indicative of intense EOL care: intubation, CPR, hospital re-admission, and ICU admission in the last 30 days of life, and location of death. The frequencies of each intense item were calculated and multivariate logistic regression was used to determine clinical (including treatment at specialty center vs non) and socio-demographic factors associated with each item and receipt of ≥ 2 items. Results: The 8,978 AYA cancer decedents were 46% non-Hispanic white, 29% Hispanic, 10% non-Hispanic black, 11% Asian; 21% had hematologic malignancies, 70% had solid tumors, and 9% had secondary neoplasms; 58% were hospitalized only at non-specialty centers in the last 6 months of life. 62% received ≥ 1 medically intense EOL care intervention, and 32% received > 2. Factors associated with > 2 intense EOL care interventions were: non-Hispanic black (OR 1.38, 95% CI 1.16-1.65), Hispanics (1.19, 1.06-1.35), Asians (1.30, 1.10-1.52); those sometimes (2.19, 1.87-2.56) or never (1.44, 1.26-1.65) seen at specialty centers; hematologic malignancies (1.77, 1.57-2.00 ref grp: solid tumors) whereas secondary malignancies were not associated with > 2 intense markers (0.68, 0.56-0.83). Conclusions: Nearly two-thirds of the AYA cancer decedents received medically intense EOL interventions and disparities exist in receipt of such care. Further research needs to determine if the disparities are due to healthcare system, patient preference, or other factors.
Improvements in communication and engagement of advance care planning in adults with metastatic cancer through a targeted team approach.
Authors: Mikan Sabrina Q. , Wilfong Lalan S. , Rhoads Margaret , Cagle Mary Ann , Taniguchi Cynthia B. 
Published: February 2017

14 Background: Advance care planning (ACP) continues to be a vital part of comprehensive, person-centered cancer care. A large community oncology practice performed a targeted approach to improve patient engagement of ACP. A process improvement project with three goals was set: increasing ACP referrals, ACP counseling visits and completed Values Assessment (VA) instrument. A leadership team consisting of practice director, physician, nurse manager, and nurse practitioner was developed with ownership of roles and responsibilities. Methods: The ACP leadership team outlined workflows to be tested, followed by evaluating outcomes of each goal over 107 days. Barriers and challenges were identified; ACP education was taught to staff. NP and RNs introduced ACP to patients during ChemoTeaching. Eligible patients were identified weekly by infusion RNs on C1D1, and patients were given the VA. Desk RNs would speak with patients on C1D2 to review symptoms and VA responses. RNs would offer ACP visits to patients. Referrals were made for patients to have one-on-one counseling with NP. Staff was educated about EMR documentation by RN manager. Weekly team phone meetings were held to discuss project status. Results: During the first 53 days of the project, 20 patients were identified at C1D1, 5 VA were completed and 15 ACP visits occurred. After evaluation, weekly communication with clinical staff increased to daily huddles. Daily communication allowed for RNs to identify C1D1 patients and communicate to the full team. During the second 54 days, 94 patients were identified at C1D1, 46 VA were completed, and 27 ACP visits occurred. A 5-fold increase occurred in patient identification; a 9-fold increase in VA completion occurred, and approximately 2-fold increase occurred in ACP counseling. Conclusions: By developing a focused and concerted process on ACP, the cancer center was able to show that patient engagement in the ACP process markedly improved. A navigation process for identifying patients who would benefit from ACP counseling was vital in increasing in the counseling visits. Continual quality improvement by refining processes in the ACP program will benefit patients.
Characteristics of patients with unscheduled versus scheduled visits to outpatient supportive care center (SCC) at a comprehensive cancer center.
Authors: Wong Angelique , Azhar Ahsan , Cerana Maria Agustina , Balankari Vishidha Reddy , Adabala Madhuri , Liu Diane D , Williams Janet L. , Bruera Eduardo 
Published: February 2017

144 Background: There is limited literature regarding outpatient palliative care, and even more limited literature describing factors associated with unscheduled visits. Our aim was to identify clinical characteristics of patients who walk-in (present unscheduled) to the outpatient SCC with the hypothesize that the patients who present for unscheduled visits have more severe symptom distress as compared to those patients who present for scheduled appointments. Methods: We compared 183 patients with unscheduled consults (CO) vs a random sample of 361 patients with scheduled CO and 159 patients with unscheduled follow-up (FU) visits vs a random sample of 318 patients with scheduled FU visits. Results: Among 544 total CO visits, unscheduled visits had worse median Edmonton Symptom Assessment Scale (ESAS) symptoms (on a scale from 0 to 10): pain (6.5 vs 4.7, p < .0001), fatigue (p = .002), nausea (p = .017), depression (p = .003), anxiety (p = 0.02), sleep (p = .0002), and overall feeling of well-being (p = 0.0009). There was no statistical difference in shortness of breath, financial distress, nor spiritual pain. Daily opioid dose (MEDD in mg) was significantly higher in unscheduled CO visits (119.7 vs 62.9, p = .0004). Among 344 total FU visits, unscheduled visits had worse median ESAS symptoms: pain (5.7 vs 4.2, p = .0001), fatigue (p = .0006), depression (p = .019), anxiety (p = .014) and higher MEDD (111.3 vs 73.6, p = .0009). There was no difference in type of insurance coverage and better ECOG (p = .015) in unscheduled vs scheduled CO visits. Unscheduled CO visits were more likely to be from outside the Houston area (161/361, 45% vs. 40/133, 30%, p < 0.0001). Conclusions: Patients who are either referred as unscheduled CO visits or who present as unscheduled FU visits have higher levels of physical and psychosocial distress and higher opioid dose. Outpatient palliative care centers need to provide opportunity for walk-in referrals for timely management of these issues.