bluuebunny/crossref_metadata_2025_split huggingface dataset:
Outcome of cancer patients admitted through the emergency department (ED) of a comprehensive cancer center: A call for ED-based palliative care.
Authors: Elsayem Ahmed F. , Silvestre Julio , Merriman Kelly W. , Chaftari Patrick S. , Gonzalez Carmen E. , Yeung Sai-ching J. 
Published: February 2017

194 Background: The National Cancer Policy Forum advocated for improving quality of end life care, and reducing cost for cancer patients. Identifying those at high risk for Intensive Care Unit (ICU) admission, and hospital death may allow earlier palliative care and avoid futile interventions. The purpose of this study is to examine risk factors for ICU admission, and hospital death among cancer patients admitted through the emergency department (ED). Methods: We queried MD Anderson Cancer Center databases for all patients who visited our ED in 2010. ICU admission and hospital deaths of these patients were reviewed, and individual patients’ data were analyzed. Results: In 2010, 16,038 ED visits were made by 9,246 unique cancer patients. Of these patients, 5,362 (58%) were admitted to the hospital at least once (range 1-13 admits). Of all patients admitted through the ED, 697 (13%) were admitted at least once to ICU. Of all patients admitted, 11% died during hospitalization; of those, 29% died in ICU. Among patients who died in ICU, 73/233 (31.3%) had hematologic malignancies and 96/354 (27.1%) had solid tumors (P<0.001). Patients admitted to ICU had median lengths of hospital stay (MLOS) of 13 days for hematologic and 8 days for solid tumors (P<0.001; using means); patients without ICU admission had MLOS of 6 and 5 days, respectively (P<0.001). In a multivariate logistic regression model for predicting in-hospital mortality, we found that ED presenting symptoms of respiratory distress or altered mental status; primary tumor of lung cancer, leukemia, unknown primary, or lymphoma; and nonwhite ethnicities were independent predictors of death. Insignificant factors included age, gender, residence, fever and pain. Conclusions: Cancer patients admitted through the ED experience high ICU admission rate, and hospital mortality. Lung and certain other cancers; race; and symptoms of respiratory distress and altered mental status were associated with increased risk of in-hospital death. Patients with these risk factors may benefit from efforts to improve palliative care and prevent futile interventions.
Pain in cancer patients: Pain assessment both by patients and family caregivers and problems experienced by caregivers.
Authors: Ovayolu Ozlem , Ovayolu Nimet , Aytac Sema , Serce Sibel , Sevinc Alper 
Published: February 2017

207 Background: Pain is among the most important symptoms in terms of prevalence and a major cause of distress for cancer patients and their family caregivers. Thus, we conducted this study with the aim to compare assessment of pain among cancer patients and their caregivers and to determine the problems experienced by caregivers. Methods: A cross-sectional and descriptive design was used. This study was conducted in a chemotherapy unit and an adult oncology clinic with 220 patients diagnosed with cancer who admitted to an oncology hospital and 220 caregivers. The study data was collected using a questionnaire and Visual Analogue Scale (VAS where “0: no pain”, 10: severe pain”). Statistically significant levels were set at p < 0.05. Results: Patients were found to experience abdominal pain most of the time (29.1%) and their pain was intermittent (67.7%), stinging (16.4%) and lasted for 0 to 2 hours. Pain was diminished after use of analgesic in 50.5% of patients, worsened with physical activity in 17.7%, was associated with nausea in 7.7% and potent opioids were used for the relief of pain in 33.2% of patients. Pain severity as assessed by patients and their caregivers was 7.1±2.8 and 7.3±2.4 respectively and the most common pain-related problems in cancer patients were fatigue (p<0.05), loss of appetite and insomnia (p>0.05) as reported by both patients and caregivers. Compared to their caregivers, patients more frequently reported pain-associated financial constraints and negative effects of cancer pain on their work life and domestic life and family relationships, all of which were statistically significant (p<0.05). The caregivers most commonly reported fatigue (56.8%) in their role as a caregiver. The caregivers were also found to experienc sleep problems (40.9%), loss of appetite (27.7%), distress (19.1%), hopelessness (17%), economic difficulty (16.8%), problems in their own life (14.1%) and fatique (12.7%). Conclusions: Pain assessments of both patients and caregivers and seeking their input on how to manage potential pain-related problems are crucial to achieve adequate pain control and distress.
Outcomes of supportive/palliative care (SPC) for advanced cancer patients (AdCa) in a general public hospital and a comprehensive cancer center.
Authors: Delgado-Guay Marvin Omar , Ferrer Jeanette , Ochoa Jewel , Cantu Hilda , Williams Janet L. , Park Minjeong , Asirot Rechelle L. , Enwemnwa Nneamaka , Flores Renee , Guanlao Rodrigo C. , Haq Faheem M , Kamineni Suchrita R. , Bruera Eduardo 
Published: February 2017

208 Background: AdCa experience severe physical, psychosocial and existential distress. Their needs might not be met only by standard care. We compared outcomes of AdCa receiving SPC at a General Public Hospital (GPH) and at a Comprehensive Cancer Center (CCC). Methods: We reviewed 364 consecutive AdCa(182 at GPH and 182 at CCC). AdCa were managed by SPC-specialists with common clinical-pathways. We assessed symptoms(Edmonton Symptom Assessment System:ESAS) and outcomes at consult and first follow-up. Results: Race was White, African-American, and Hispanic in 42(23%), 70(39%), 63(35%) at GPH vs. 112(64%, p<0.0001), 30(17%, p<0.0001), 20(11%, p<0.0001) at CCC, respectively. Age, gender and cancer diagnoses were similar at both sites. 98(54%) at GPH vs. 181(99%) at CCC reported to have some health-insurance(p<0.0001). Symptoms at consult-time at GPH and CCC: Pain 133(85%) vs. 151(91%,p=0.0586); Fatigue 127(80%) vs. 153(94%,p<0.0001); Nausea 69(44%) vs. 89(55%,p=0.0438); Depression 79(51%) vs. 109(68%,p=0.0015); Anxiety 72(46%) vs. 121(75%,p<0.0001); Drowsiness 78(50%) vs. 119(76%, p<0.0001); Appetite 89(56%) vs. 146(91%, p<0.0001); Dyspnea 72(46%) vs. 107(65%,p=0.0004); Sleep 90(59%) vs. 142(88%,p<0.0001); and Well-Being 95(63%) vs. 132(93%,p<0.0001). Both SPC provided multiple not different interventions: opioid-management, medication review for polypharmacy, bowel-regimen, antiemetics, and interdisciplinary counseling. At follow-up ESAS-improvement(decrease ≥2 points) was: pain 21/80(26%) at GPH vs. 43/107(40%) at CCC(p=0.0469), anxiety 18/75(24%) vs. 40/98(41%,p=0.0202); appetite 15/74(20%) vs. 37/90(41%,p=0.0043); sleep 20/74(27%) vs. 42/95(44%,p=0.0215); nausea 23/77(30%) vs. 35/97(36%,p=0.3879); depression 18/74(24%) vs. 30/94(32%,p=0.2796). Median Time(range) from consult-to-follow-up at GPH 21 days(0-427) vs. 14 days(1-275,p=0.032), and from consult-to-death at GPH 53 days(1-699) vs. 51 days(1-898,p=0.8473). Conclusions: AdCa at GPH and CCC had frequent and severe-symptoms. Response-rate was lower and follow-up less-frequent at GPH. SPC needs to be more frequent and more resources are needed at GPH.
Safety of biosimilar filgrastim in patients undergoing neutropenia-inducing chemotherapy: Next study.
Authors: Maloisel Frederic , Leprêtre Stephane , Kamioner Didier , Berthou Christian , Albrand Helene 
Published: February 2017

211 Background: Febrile neutropenia (FN) is a serious, frequent complication of cytotoxic chemotherapy (CT). Biosimilar filgrastim (Nivestim, Hospira Inc.) is a granulocyte-colony stimulating factor (G-CSF) licensed for the treatment of neutropenia and FN induced by myelosuppressive CT. The NEXT (Nivestim safety profile in patients [pts] treated with cytotoxic CT in real-life clinical practice) study aimed to assess the safety of biosimilar filgrastim in pts undergoing CT for malignancies (excluding chronic myeloproliferative and myelodysplastic syndrome) and receiving biosimilar filgrastim as prophylaxis, or as curative treatment. Methods: NEXT was a prospective, non-interventional, longitudinal, multicentre study conducted in France. Recorded data included pt demographic and clinical characteristics, biosimilar filgrastim treatment-related data on efficacy and safety, such as adverse events (AEs), including FN. Pts were monitored for 1–6 CT cycles with three visits at inclusion, during treatment, and following CT. Results: Overall, 2114 pts were enrolled in the study. Of these, 2,102 pts were analysed (50.2% male). Mean age ± SD was 63.5 ± 12.7 years. 75% of pts had solid tumours and 25% had haematological malignancies. The majority (98.2%) of pts received prophylactic biosimilar filgrastim and 1.8% for curative intent. At inclusion, 92.5% of patients had no prior FN; 34.4% had prior CT; 20.2% had prior G-CSF therapy. During the study 20.4% of pts experienced ≥1 AE; AEs were reported most frequently in pts with acute leukaemia (40.0%), lymphoma (21.9%) and solid tumours (21.1%). 12.7% of pts reported bone, muscular or chest pain. 4.9% of pts experienced FN and 3.1% had an infection. Conclusions: Biosimilar filgrastim (Nivestim) was effective and well-tolerated in both the prophylactic and curative setting in pts undergoing CT for solid tumours and haematological malignancies. Biosimilar filgrastim seems to be as efficacious and as well tolerated compared with the reference filgrastim (Neupogen, Amgen) regarding retrospective data. Clinical trial information: NCT01574235.
Prognostic understanding, quality of life (QOL), and mood in patients undergoing hematopoietic stem cell transplantation (HCT).
Authors: El-Jawahri Areej , Traeger Lara , Eusebio Justin , Kuzmuk Kailyn , Vandusen Harry , Shin Jennifer , Gallagher Emily R. , Greer Joseph A. , Pirl William F. , Ballen Karen K. , Spitzer Thomas R. , Graubert Timothy A. , McAfee Steven L. , Dey Bimalangshu , Jackson Vicki A. , Chen Yi-Bin Albert , Temel Jennifer S. 
Published: February 2017

219 Background: In advanced cancers, patients’ prognostic perceptions influence their medical decisions. However, little is known about how patients with hematologic malignancies undergoing HCT and their family caregivers (FC) understand their prognosis. We examined prognostic perception in these patients during hospitalization for HCT and its relationship with QOL and mood. Methods: We conducted a longitudinal study of patients (and FC) hospitalized for HCT. At baseline (6 days pre-HCT), we used a 10-item questionnaire to measure patients’ and FC information preferences, and perception of prognosis. Using 2-items, we also asked oncologists regarding the patients’ prognosis. At day-6, day+1, day+8 of HCT, we assessed QOL (Functional Assessment of Cancer Therapy-Bone Marrow Transplantation FACT-BMT), and mood (Hospital Anxiety and Depression Scale). We examined the relationship between patients’ prognostic perception and their QOL and mood during hospitalization for HCT using multivariable linear mixed models. Results: We enrolled 97% of consecutively eligible patients undergoing autologous (n=30), myeloablative (n=30) or reduced intensity (n=30) allogeneic HCT. Most patients (80/90, 88.9%) and FC (41/47, 87.1%) believed that it is ‘extremely’ or ‘very’ important to know about prognosis. However, the majority of patients (66/85, 77.6%) and FC (33/46, 71.7%) reported an inaccurate and more optimistic perception of the patients’ prognosis compared to the oncologist (P < 0.0001). Patients with accurate prognostic understanding reported lower QOL (P = 0.03) and worse depressive symptoms (P = 0.04) with a steeper increase in depression (P = 0.006) over time compared to patients with an inaccurate optimistic prognostic perception. Conclusions: The majority of patients and FC reported inaccurate and more optimistic perception of prognosis compared with the oncologist. Patients with an accurate perception of their prognosis had lower QOL, higher depression, and a steeper increase in depression during hospitalization for HCT. Interventions are needed to improve prognostic understanding while providing adequate psychosocial support during HCT.
Improving management of breathlessness in lung cancer.
Authors: MacDonald James John , Temel Jennifer S. , Viscosi Elene , Vaughn Jeanne Griffin , Traeger Lara , McDonnell Theresa Margaret , Pirl William F. , Greer Joseph A. 
Published: February 2017

220 Background: Dyspnea is a common and debilitating symptom of advanced lung cancer that interferes with quality of life (QOL). Though few evidence-based treatments for dyspnea exist, there is support for non-pharmacological interventions that include elements of cognitive-behavioral therapy (CBT). The purpose of this study was to pilot a brief nurse-delivered CBT intervention for dyspnea in patients with lung cancer, assessing feasibility and effect. Methods: For this single-group, nonrandomized pilot trial, 20 patients receiving outpatient chemotherapy for advanced lung cancer (ECOG Performance Status 0-2) and reporting dyspnea participated in a two-session CBT intervention. We enrolled a convenience sample of patients referred by their medical oncologists based on self-reported dyspnea. Two nurse practitioners taught the participants breathing and relaxation techniques within the infusion clinic and encouraged home practice. Patients completed measures of dyspnea (Modified Medical Research Council Dyspnea Scale [MMRCDS]), QOL (Functional Assessment of Cancer Therapy-Lung [FACT-L] and Trial Outcome Index [TOI]), and depression symptoms (Hospital Anxiety and Depression Scale depression subscale [HADS-D]) at baseline and within 6 weeks after enrollment. We used dependent-samples t-tests to analyze treatment effect on dyspnea and QOL and sign test to analyze depressions symptoms. Results: Of the 20 patients (50% Female; Mean Age=64.80 years) enrolled in the study, 85% (17) completed post-assessment. We observed significant improvement in MMRCDS (p=.001), FACT –L (p=.029), and FACT-TOI (p=.008) scores from baseline to post-assessment. The proportion of patients reporting depression symptoms (e.g. HADS-D >7) decreased from 50% (n=10/20) to 12 % (n=2/17) (p=.016). Conclusions: In this sample of patients with advanced lung cancer and dyspnea, we observed a high completion rate for the 2-session CBT intervention. Patients also showed improvements in dyspnea, QOL, and mood. Follow-up randomized controlled trials are needed to examine the efficacy of brief CBT interventions for dyspnea. Clinical trial information: NCT01937637.
Relationship between the cancer-specific comprehensive score for financial toxicity (COST), patient-reported outcome, and health-related quality of life (HRQOL) in patients with advanced cancers.
Authors: De Souza Jonas A. , Yap Bonnie J. , Hlubocky Fay J. , Daugherty Christopher 
Published: February 2017

222 Background: Financial toxicity is an important Patient Reported Outcome (PRO). Its relationship with HRQOL has not been previously described. Therefore, we report the relationship between financial toxicity and HRQOL in patients with advanced cancers. Methods: HRQOL was measured by the EORTC QLC-C30 global health status and its functional scales. Financial toxicity was assessed by the COST (COmprehensive Score for financial Toxicity), a cancer-specific PRO measure developed in 155 patients with advanced cancers. The Personal Financial Wellness Scale (PFW), a non-cancer specific financial measure, as well as the EORTC perceived financial impact (FI), were used to assess convergent validity. The Marlowe-Crowne Social Desirability Scale and the Brief Profile of Mood States were included to demonstrate divergent validity (i.e., no significant relationship should exist between self-reported financial toxicity and social desirability and total mood disturbance). Spearman’s correlation coefficients were used to assess the strength of relationships. Results: Fifty patients were assessed. All participants were diagnosed with advanced cancers, were receiving treatment at the time of participation, and had received treatment for at least 3 months. A negative correlation existed between the COST and HRQOL as measured by the EORTC (r = -0.32, p < 0.05). The highest correlation was found between COST and the EORTC Emotional Functioning Scale (r = - 0.34, p < 0.05). The COST had high correlations with the PFW scale (r = 0.86, p<0.0001) and FI (r = 0.74, p < 0.0001), indicating convergent validity. The association between financial toxicity and social desirability and mood states were not statistically significant (r = 0.16, p = 0.28 and 0.20, p = 0.15, respectively), indicating divergent validity. Conclusions: Results demonstrate an inverse relationship between patient-reported HRQOL and financial toxicity, suggesting that higher financial toxicity is associated with worse HRQOL in this small sample of patients. There was no correlation between COST and social desirability and mood disturbances, as expected.
Work and financial disparities among adult cancer survivors in the United States.
Authors: Whitney Robin L. , Bell Janice , Reed Sarah , Davis Andra , Lash Rebecca Salisbury , Kim Katherine , Copenhaver David , Bold Richard J. , Joseph Jill G. 
Published: February 2017

238 Background: The prevalence of cancer in the US continues to increase, with 18.1 million projected survivors by 2020. Few recent population-based studies have examined cancer-related work and financial disparities in this growing population. Methods: Cancer-related work modifications (e.g., changing to a flexible schedule or less demanding job, early or delayed retirement, extended or unpaid time off) and financial difficulties (e.g., debt, worry about medical bills, bankruptcy) were examined in the 2011 Medical Expenditures Panel Survey Experiences with Cancer Survivorship Supplement (n=1,592). Survey-weighted logistic regression was used to model the odds of having any work modification or financial difficulty and negative binomial regression to model counts of these outcomes as functions of survivorship status (i.e., active treatment, <5 years post-treatment, and ≥5 post-treatment=reference) and socio-demographic covariates. Results are generalizable to the civilian, non-institutionalized US population. Results: Among survivors, 27% reported at least one financial difficulty and 37% reported making work modifications due to cancer. Significant predictors of work modifications included: active treatment (OR 2.9; 95% CI 1.7-4.9), with 40% more modifications than those ≥5 years post-treatment; females (OR 1.5; 95% CI 1.1-2.2), with 30% more modifications; and race/ethnicity other than white (OR 1.7; 95% CI 1.1-2.6,), with 54% more modifications. Significant predictors of financial difficulties included: active treatment (OR 3.2; 95% CI 2.1-5.0), with 92% more difficulties; age <65 years (OR 2.4; 95% CI 1.7-3.3), with 130% more difficulties; no insurance (OR 2.4; 95% CI 1.3-4.4), with 67% more difficulties; and race/ethnicity other than white (OR 1.6; 95% CI 1.1-2.3), with 41% more difficulties. Conclusions: Significant work and financial disparities exist among US cancer survivors, particularly women, younger survivors, racial/ethnic minorities, and those without insurance. Active treatment predicted these concerns, but did not fully account for observed disparities. Screening and support for work and financial concerns is needed across the survivorship trajectory, with particular attention to groups at risk.
Extended impact of an embedded palliative care program in a community cancer center.
Authors: Kalisiak Angela , Glenn Lyn A. , Weinmeister Mark 
Published: February 2017

24 Background: High-level evidence has demonstrated that earlier palliative care (PC) improves outcomes for patients with advanced cancers, but a limited PC workforce and lack of outpatient resources remain barriers to access. In 2010, a productive intersection of oncologist-driven response to new evidence and Providence Cancer Center assessment of end of life care quality metrics resulted in funding of an outpatient Oncology Palliative Care Program (OPCP). An initial NP/LCSW team began concurrent PC for advanced lung and pancreas carcinoma patients in a specialty clinic setting in 2011. Scope of service was expanded to include other diagnoses in 2012. Early positive outcomes and oncology team feedback led to Cancer Center funding of a second PC team at a separate service site in August 2013; the OPCP simultaneously transitioned to an embedded care model. Methods: Retrospective chart review of patient deaths for all Providence Medical Group (PMG) Cancer Center patients not served by OPCP; review of OPCP referral data since adoption of embedded model (n= 177). Quarterly quality metrics included: % patients on hospice at time of death; % patients with evidence of an Advance Care Planning (ACP) discussion documented in the electronic medical record (EMR); and % patients receiving chemotherapy at end of life. Results: A significant improvement in the % PMG oncology patients with evidence of an ACP discussion occurred from 2010 baseline of 59.5% to 74.5% in 2013 (z=4.03, p<.001). In addition, % patients receiving chemotherapy in the last 14 days of life decreased from 5.9% in 2010 to 2.7% in 2013 (z=1.9; p<.05). For patients referred to the OPCP, referral diagnoses evolved from 100% lung and pancreas carcinoma to 34 % lung and pancreas carcinoma and 66 % other diagnoses. Conclusions: Incremental growth of the Providence OPCP has demonstrated successful expansion to diagnoses beyond end stage lung carcinoma. Improvement in end of life care quality metrics for oncology patients not served by the program (perhaps by elevating "generalist" PC skills) may be an additional benefit and value of a highly visible embedded PC team in a community cancer center, particularly with respect to modeling best practice of early goals of care discussions and ACP.