bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cost analysis of a randomized trial of early palliative care (PC) in patients with metastatic non-small cell lung cancer (NSCLC).
Authors: Greer Joseph A. , Tramontano Angela , McMahon Pamela M , El-Jawahri Areej , Parikh Ravi Bharat , Gallagher Emily R. , Pirl William F. , Jackson Vicki A. , Muzikansky Alona , Temel Jennifer S. 
Published: February 2017

4 Background: Several randomized, controlled trials have shown that early, integrated palliative and oncology care improves quality of life, mood, and symptom burden in patients with advanced cancers. However, the degree to which early involvement of specialty PC in the ambulatory care setting impacts the cost of care remains unknown. We investigated the health care costs for patients with metastatic NSCLC enrolled in a clinical trial of early PC. Methods: For this secondary analysis, we examined data from a randomized trial of 151 patients with newly-diagnosed metastatic NSCLC from 06/2006 to 07/2009. Patients received either early PC integrated with standard care or standard care (SC) alone. We abstracted costs for emergency and inpatient care, outpatient visits, intravenous chemotherapy, and physician services from the hospital’s accounting system. Oral chemotherapy costs were estimated based on actual drug charges for patients. To estimate hospice costs, we used Medicare reimbursement rates. For each participant, we calculated the average total cost of care per day for the entire study period as well as the total cost of care for the final 30 days prior to death. Costs differences between groups were examined with the Wilcoxon Rank-Sum Test. Results: We analyzed health care costs of the 138 patients who died by 07/15/2013 (early PC N=68; SC N=70). The mean number of days on study was longer for patients assigned to early PC (M=397, SD=360) versus SC (M=299, SD=266). Over the study period, early PC was associated with a lower average total cost per day of $117 (SD=$436) compared to SC (p=.09). In the final 30 days of life, patients in the early PC group incurred higher total costs for hospice care (Mean difference=$1,053, SD=$3,162, p=.11), while expenses for chemotherapy were less (Mean difference=$757, SD=$2,143, p=.06). No cost differences between groups met the threshold for statistical significance. Conclusions: Although this secondary analysis was inconclusive due to the lack of statistical power to examine differences in cost outcomes, the delivery of early PC for patients with metastatic NSCLC does not appear to increase health care expenses over the course of disease or at the end of life. Clinical trial information: NCT01038271.
Barriers to palliative care in outpatient oncology practice.
Authors: Wilfong Joshua Murray , Silveira Maria 
Published: February 2017

45 Background: In 2009 ASCO released a policy statement recommending integration of palliative care as part of comprehensive cancer care. The various needs of cancer patients and the complex organization of health care makes this integration challenging. With this idea in mind, we conducted focus groups with oncologists and oncology nurses to identify the barriers to providing palliative care within oncology. Methods: We conducted 11 focus groups with oncologists and their nursing staff at 5 sites throughout Southeast Michigan to explore their care of patients with incurable and advanced cancer. Physicians and nurses were interviewed separately. Interviews were taped, transcribed, and analyzed using cross-case comparison. Transcripts were reviewed by multiple readers to: 1) develop a coding scheme, 2) identify themes, and 3) design an interpretive model. Results: Oncologists and their nursing staff acknowledge the importance of providing high quality palliative care to their patients. Multiple barriers that affect their abilities to provide the quality of palliative care that they desire for their patients were discussed. These issues include 1) Time limitations for discussion of symptoms and advance care plans during office visits; 2) Limited access to secondary supports (e.g. palliative care physicians, social workers, and psychiatrists) available and difficulty coordinating a timely referral; 3) Limited availability of effective case management and telephone care for coordinated patient communication between visits. Conclusions: Oncologists and their nursing staff value and acknowledge the importance of providing their patients with high-quality palliative care but multiple limitations in the organization of oncology care prevent them from doing so. Allowing longer visits, access to secondary supports, and effective case management may improve the quality of palliative care offered within outpatient oncology.
Patient-reported outcomes for determining prognostic groups in veterans with stage IV solid tumors starting systemic therapy.
Authors: Chang Victor Tsu-Shih , Scott Charles B. , Gonzalez Melanie L. , Einhorn Jan , Yan Houling , Sullivan Maryann , Srinivas Shanti , Zhong Fengming , Crump Barbara , Paz-Querubin Emma R , McPherson Monica , DeMarco Celeste , Kasimis Basil 
Published: February 2017

48 Background: A Recursive Partitioning Analysis (RPA) prognostic algorithm based on quality of life and symptoms predicted 4 groups with distinct median survivals in patients with metastatic solid tumors receiving chemotherapy (ASCO 2013, Abst 9567). We update our findings. Methods: The RPA algorithm is based upon Karnofsky performance status (KPS), Functional Assessment of Cancer Therapy (FACT) physical well-being (PWB) subscale, and Memorial Symptom Assessment Scale Short Form (MSAS-SF) physical symptom distress (PHYS) subscale. Starting in 2007, a convenience sample of Veterans who were prescribed systemic treatment for their cancer was enrolled in an IRB approved protocol, and completed quality of life (FACT- G) and symptom (MSAS SF) questionnaires at the first cycle of treatment. We analyzed records of patients with stage IV metastatic solid tumors enrolled through June 2013, and determined survival as of June 15, 2014. Analyses were performed with STATA 11.0. Results: There were 97 patients(pts). The median age was 64 yrs, range 27-88. Males comprised 95 (98%) pts. First line chemotherapy was given to 78 (80%) pts. The most common primary sites were lung cancer 33 (35%), prostate 17 (17%) and colon 11 (11%) pts. Median KPS was 90% range 40-100%, PWB median 23 (range 6-28), and MSAS SF median PHYS 0.76 (range 0-3.2). Overall median survival was 285 days (range 6-2,358) and 80 pts (82%) had died. There was 1 pt in group 1, 58 in group 2, 12 in group 3, and 23 in group 4. The patient in group 1 had uterine sarcoma. Median survival (days) by RPA group was 155 for group 1, 177 for group 2, 292 for group 3, and 674 for group 4 (p=.011). Conclusions: These preliminary findings suggest that this algorithm is capable of dividing patients with metastatic solid tumor who are starting systemic therapy into prognostic groups. Further development is indicated.
Joint modeling, quality of life, and survival in fast-track (or delayed-start) palliative care trials.
Authors: Li Zhigang , Frost H.R. , Yang Qian , Bakitas Marie , Tosteson Tor 
Published: February 2017

49 Background: Randomized “early intervention” or “fast-track” trials (also sometimes called delayed intervention, delayed-start, or wait list designs) have been proposed as an alternative to traditional RCTs comparing palliative care interventions to non-palliative or other supportive care groups. The fast-track arm receives intervention immediately after randomization and the control arm receiving intervention after a certain period following randomization during which time standard care is provided. Such trials are more acceptable to patients, families and physicians because no one is denied access to the intervention, while still allowing for a rigorous assessment of a palliative care intervention. Many issues remain with respect to implementing such designs and analyzing the longitudinal quality of life and survival. Methods: We have developed a terminal decline model (Li et al. 2013) for jointly modeling quality of life and survival in palliative care studies. This model can be implemented on an intention to treat basis for the overall comparison in fast track design. For time periods beyond the delayed start period, we modify the model to include a time-varying treatment variable in the model to account for the treatment change in the control arm, including an interaction between the treatment and the time period. Terminal declines and quality-adjusted life years are estimated for both the intention to treat and the modified model. Results: ENABLE III is a recently completed fast-track trial in our institution at Dartmouth. After applied to ENABLE III study, the novel statistical joint modeling approach indicates that the effect of the ENABLE intervention on the terminal decline increases when combined with intervention effect seen for fast track arm. Conclusions: The terminal decline joint modeling approach is an efficient and interpretable method for fast-track study designs.
The availability of and satisfaction with palliative care services among VHA-based radiation oncologists.
Authors: Dawson George A. , Cheuk Alice V. , Jolly Shruti , Gutt Ruchika , Moghanaki Drew , Fosmire Helen , Lutz Stephen T. , Hagan Michael Philip , Anscher Mitchell Steven , Hoffman-Hogg Lori , Kelly Maria D. 
Published: February 2017

55 Background: Palliative care services enhance quality of life in patients with advanced malignancies and are an integral component of multidisciplinary cancer care. They provide symptom control and psychosocial support for patients and family members. A survey in non-VHA cancer centers showed that despite availability of palliative care programs, there was wide variability in the use of these services (Hui et al, JAMA 2010). Palliative care services are a component of the VHA medical benefits package. We sought to determine the ease of access to palliative care services and provider satisfaction among VHA Radiation Oncologists. Methods: VHA-based Radiation Oncologists were identified using the National VHA Radiation Oncology list serve group. All practicing Radiation Oncologists were surveyed to determine the extent of Palliative Care Services available to them and to measure their level of satisfaction with these services. Eighty two surveys were electronically mailed to practitioners at the 38 active VHA Radiation Oncology sites, followed by a reminder phone call.This survey was conducted over a four week period in May of 2014. Results: Sixty four of the 82 surveys distributed over the 4 week period, or 78% were completed. They represent 89% (34/38) of VHA Radiation Oncology Services. All respondents had Palliative Care Services available to them and 98% were happy with the services rendered by the Palliative Care teams. Conclusions: All VHA-based Radiation Oncologists who responded to this survey have access to local VHA based Palliative Care Services. This represented 82% of VHA Radiation Oncology practitioners and 98% were satisfied with the services rendered. Further studies should explore the scope and extent of palliative care involvement including when these services are integrated into the management of patients with advanced malignancies, availability of outpatient palliative care services and variations in care delivery. Radiation therapy is utilized in over 50% of patients with malignancy, often in advanced disease for symptom management and standard guidelines integrating radiotherapy and palliative care should be developed.
Using palliative care to maximize the value of care for patients with advanced cancer.
Authors: Gidwani Risha , Gale Randall , Meier Diane E. , Asch Steven M 
Published: February 2017

59 Background: Cancer is one of the highest cost conditions in the United States, with growth in cancer costs outpacing general medical costs. This is troubling from a patient perspective. Patients with cancer experience significantly greater financial burdens compared with patients with other medical conditions. Many patients forgo or discontinue cancer treatment partly because they do not want to burden their families with significant debt. The growth of cancer and other medical costs is also threatening the health of the U.S. economy, prompting calls for the need for high-value practices. In healthcare, value indicates an achievement of patient outcomes proportional to the resources spent to achieve them. Increasing the provision of palliative care may be one way to achieve higher value care in cancer. Methods: We summarize the literature regarding palliative care, patient outcomes, and costs to assess the value of palliative care in advanced cancer. We also review the literature to identify reasons for low patient receipt of palliative care. Results: Palliative care represents a strong opportunity to improve the value of cancer care. Palliative care is associated with better informed and more satisfied patients and families, a reduction in use of undesired medical services, and does not pose a risk of increased mortality. Reasons for low rates of palliative care include a mismatch between how patients perceive palliative care and how physicians believe patients perceive palliative care, a lack of familiarity with locally-available palliative services, and a perceived incompatibility with cancer therapy. Conclusions: Palliative care for patients with cancer can improve the patient and family experience while maximizing value for the healthcare system and averting unnecessary patient financial burden. Systems redesign is needed in order to support oncologists in supporting the palliative care needs of their patients and realizing this high-value cancer care.
Subgroup analysis of ECOG2 patients from ROMANA 2: A phase III study of anamorelin in NSCLC patients with cachexia.
Authors: Abernethy Amy Pickar , Currow David Christopher , Gleich Lyon L. , Yan Ying , Friend John , Temel Jennifer S. 
Published: February 2017

6 Background: Cancer anorexia-cachexia syndrome (CACS), often observed in NSCLC patients, is characterized by decreased body weight, mainly lean body mass (LBM), and is associated with worse morbidity and survival. Anamorelin HCl (ANAM), a novel selective ghrelin receptor agonist with appetite-enhancing and anabolic activity, is in development as a treatment of NSCLC CACS. Methods: ROMANA 2 was one of two global, double-blind, Phase III trials assessing ANAM efficacy and safety in NSCLC. Patients with unresectable stage III/IV NSCLC, ECOG 0-2 and cachexia (≥5% weight loss within prior 6 months or BMI <20 kg/m2), were randomized (2:1) to 100 mg ANAM or placebo, given daily orally for 12 weeks. Co-primary endpoints were change from baseline over 12 weeks in LBM (measured by DXA) and in handgrip strength (HGS). Secondary endpoints included change in patient symptoms/concerns regarding anorexia-cachexia and fatigue (via Functional Assessment of Anorexia/Cachexia Treatment [FAACT] and Functional Assessment of Chronic Illness Therapy – Fatigue [FACIT-F]). Safety assessments included lab values and adverse events (AEs). This pre-specified analysis focused on ECOG2 patients. Results: ROMANA 2 (N=495) enrolled 130 ECOG2 patients (N=41 placebo; N=89 ANAM). Subgroup demographics were balanced: median age= 64 yr, male (81.5%), metastatic (74.6%), and prior weight loss >10% (61.5%). In the overall trial, ANAM significantly increased LBM vs placebo (0.75 vs -0.96 kg; p<0.0001) and improved FAACT over 12 weeks (3.48±0.9 vs 1.34±1.0; p=0.0016); change in HGS was not statistically different. In the ECOG2 subgroup, ANAM also significantly increased LBM (0.45 vs -2.66 kg; p=0.0004); there was a trend towards improvement in FAACT and FACIT-F but this was not statistically significant. In the ANAM arm of the ECOG2 subgroup, the most frequent drug-related AE was hyperglycemia (4.5%), with few (1.1%) drug-related Grade ≥ 3 AEs. Conclusions: ANAM treatment for 12 weeks was well tolerated. In patients with ECOG2 performance status, which represents a more severe/fragile population, ANAM improved LBM, as well as anorexia-cachexia and fatigue symptoms/concerns in advanced NSCLC cachectic patients. Clinical trial information: NCT01387282.
Developing a new model of care for patients with cancer who present to the emergency department: The Mayo Clinic experience.
Authors: Wong Debra A. , Fitch Tom R. , Prommer Eric , Chang Yu-Hui , Lipinski Christopher A. 
Published: February 2017

61 Background: Patients with cancer often have complex symptoms and morbidity that prompt frequent Emergency Department visits. The length of stay in the ED for cancer patients exceeds that of patients without cancer. Patients with cancer are also more likely to be admitted, but are often discharged within 72h. Protracted ED visits, extensive investigations, and the burdens of even a short admission may be distressing and may not be aligned with patients’ care goals and preferences. Furthermore, the healthcare resources dedicated to these patients is considerable and has economic implications. We recently established a Supportive Care Infusion Center (SCIC), an on-campus outpatient unit where patients can receive treatments for symptom relief and comfort; they are assured integrated palliative care with routine oncologic care. We believe there is a subset of cancer patients who can be safely transferred from the ED to the SCIC for appropriate care. Methods: We are retrospectively evaluating cancer patients admitted through the ED to validate clinical parameters likely to lead to admission, and also identify any differences between patients admitted for <72h vs >72h. Patients are analyzed based on symptoms, cancer type, prior cancer therapies, performance status, comorbidities, and presence/absence of advance care planning as well as previous contact with Palliative Care. Data are also being gathered on patient outcomes, including mortality within 60d of admission. Results: Previously established indicators predictive of admission included shortness of breath and SIRS criteria, which our current review validates. We also observe that patients admitted for >72h have greater symptom burden and comorbidities and have received multiple lines of therapy. They also less frequently have advance care planning in place. Data analysis is ongoing. Conclusions: There exists a difference between cancer patients admitted >72h and those discharged within 72h. Awareness of these characteristics may lead to improved workflow in the ED. Identifying patients who may be suitable for transfer to an outpatient supportive care unit rather than short-term admission will also facilitate cost-effectiveness. Future direction includes evaluation of outcomes such as mortality, quality of life, and patient-caregiver satisfaction.
Do newly diagnosed cancer patients require palliative care? An audit at a regional cancer center in India.
Authors: Ghoshal Chakrabarti Sushmita , Miriyala Raviteja , Elangovan Arun , RAI Bhavana 
Published: February 2017

65 Background: The present study was planned to record the distressing symptoms of newly diagnosed cancer patients and to evaluate how the symptoms were addressed by the treating oncologists. Methods: All newly diagnosed cancer patients referred to the department of Radiotherapy during the month of May 2014 were asked to fill a questionnaire after taking their consent. The ESAS-r questionnaire was used to assess the frequency and intensity of distressing symptoms. The case records of these patients were then reviewed to compare the frequency and intensity documented by the treating physician. The difference in the two sets of symptoms documented were statistically analysed by non-parametric tests using SPSS. Results: Eighty-nine patients participated in this study out of which only 19 could fill the questionnaire on their own. Anxiety was the commonest symptom (97.8%) followed by depression (89.9%), tiredness (89.9%) and pain (86.5%). The treating physicians recorded pain in 83.1% while the other symptoms were either not documented or grossly under reported. Anxiety was documented in 3/87 patients but depression was not documented in any. Tiredness was documented in 12/80 patients, loss of appetite in 54/77 patients mentioning them in the questionnaire. Significant statistical correlation could be seen between the presence of pain, anxiety, depression, tiredness and loss of appetite in the patients. Conclusions: The study reveals that the distressing symptoms experienced by newly diagnosed cancer patients are grossly under reported and inadequately addressed by treating oncologists. Sensitizing the oncologists and incorporating palliative care principles early in the management of cancer patients could improve their holistic care.
The Orkdal model: Development, implementation, and evaluation of collaboration between specialist and community care within cancer palliative care.
Authors: Brenne Anne-Tove , Knudsen Anne Kari , Brunelli Cinzia , Halsteinli Vidar , Kaasa Stein 
Published: February 2017

73 Background: Palliative care early in the cancer disease trajectory may improve health related quality of life for patients and their families. Collaboration between community and specialist health care professionals is paramount to achieve optimal cancer care. The objective of this study is to develop and to implement this model into our health care system.The target population is cancer patients with metastatic and/ or loco-regional disease. Methods: The study takes place in a rural district of 13 municipalities with a local hospital (Orkdal) in Mid Norway. It is designed as a prospective controlled observational pre- post cohort study with four main interventions: 1. Development and implementation of a standardized care pathway across health care levels, 2. Educational programme for health care professionals, 3. Information about cancer and palliative care to the public, 4.Information,education and support to family members.Outcomes are patient’s time spent at home, family member’s health related quality of life, improvement of health care providers’ knowledge and skills and distribution of health care service use. Results: A standardized care pathway for all palliative cancer patients including home care, care in nursing homes, and specialist care in hospitals (in- and outpatients) is developed. It focuses on access to palliative care services, transfer of medical data, and symptom assessment. The educational program consists of two parts; one to inform about the project and the standardized care pathway, and one to improve competence and skills in cancer palliative care. To the general public, information regarding chemo- and radiotherapy, symptom diagnosis and treatment and palliative care services in general is given. Conclusions: A total integrated model to improve care for cancer patients was developed focusing on collaboration between community and specialist health care, and on early integration of palliative care in the traditional cancer care trajectory. Improved care for cancer patients and their families in the Orkdal region to equal costs is expected. The Orkdal Model may be applied in other regions and for other chronic diseases. Clinical trial information: NCT02170168.