bluuebunny/crossref_metadata_2025_split huggingface dataset:
Predictors of trust in the medical profession among cancer patients receiving palliative care: A preliminary study.
Authors: Tanco Kimberson , Rhondali Wadih , Park Minjeong , Liu Diane D , Bruera Eduardo 
Published: February 2017

60 Background: Trust influences health care through the willingness to seek and continue care, disclose sensitive information, adhere to treatment, and satisfaction with care. In a recent prospective study of patient perception of physician compassion, the degree of trust in the medical profession was found to be significantly associated with higher perception of compassion. In this secondary analysis, we explored the association between trust and other demographic and psychosocial factors. We also explored the performance of the single item Degree of Trust scale compared to the validated 5-item Trust in Medical Profession scale. Methods: A secondary analysis of prospectively collected data was performed. Trust scores completed by 100 patients were correlated with age, gender, ethnicity, educational level, anxiety, depression, hopefulness, and a 0 (best) – 10 (worst) Degree of Trust question. Results: Scores were 13, 11-14 [median, IQR; inversely scored] for Trust in Medical Profession and 2, 1-4 [median, IQR] for Degree of Trust with moderate correlation [r = 0.587, p < 0.001]. On evaluating performance of Degree of Trust scale to the validated Trust in Medical Profession scale, a moderately high performance was found [Youden’s J = 0.73; Topleft = 0.21]. Older age [57, 49-65 (median, IQR), p = 0.02] lower depression scores [6,3-9 (median, IQR), p < 0.01] and more hopefulness [22,20-25 (median, IQR), p = 0.01] were associated with higher levels of trust. Conclusions: Trust was associated with older age, less depressed and more hopeful patients. A single 0-10 item trust scale was found to perform adequately compared to a multiple item questionnaire.
Cancer symptom scale preference: One size to fit all?
Authors: O'Connor Brenda , Jeter Kirby , Blackwell Siobhan , Burke Lucy , Conway Emma Victoria , Moran Catherine , Cremen Iseult , Ui Dhuibhir Pauline , Joyce David , Walsh Declan 
Published: February 2017

69 Background: Systematic assessment in cancer is conducted by a variety of instruments. Such assessment is important as comprehensive instruments detect more symptoms than casual clinical evaluation. In choosing assessment scales for polysymptomatic cancer patients one must consider the burden of assessment to ensure satisfactory completion rates. This study investigated patient preference and clinical utility of symptom assessment scales. Methods: A prospective survey was conducted in an Irish palliative medicine inpatient unit.Consecutive cancer admissions were recruited within 7 days. Patients’ preferences were elicited with regards to 3 symptom assessment scales; categorical response (CRS), numerical rating (NRS), and visual analogue (VAS), across 3 common symptoms; appetite loss, pain, and tiredness. Participants selected their preferred scale per symptom. We determined the clinical utility of each scale, defined by ease of completion as judged by an observer. Results: 100 participants wererecruited,aged 38-93 years (x̅ = 71 years; SD=11.6). Median European Cooperative Oncology Group (ECOG) score was 2 (range 0-4). Participants preferred CRS for appetite loss (48%) and tiredness (40%), and NRS for pain (44%). VAS was consistently the least preferred measure. Scale preference was fully consistent across symptoms for 52% of patients, with just 4% choosing a different scale per symptom. There was moderate agreement between participant scale preference and ease of completion as determined by observer (Pain: K=0.486; Fatigue: K=0.452; Appetite loss K=0.364). Conclusions: (1) Most participants had a specific scale preference which was consistent across symptoms, (2) CRS was preferred overall, (3) Participants did not need to experience a symptom to have a preference, (4) VAS should be used with caution in hospice clinical care or research, (4) Symptom assessment scales should be carefully selected for clinical and research purposes.
Patterns of failure and morbidity associated with palliative intervention in patients with malignant biliary obstruction.
Authors: McFarlane Matthew Ryan , Pillai Anil , Porembka Matthew , Meyer Jeffrey John , Kubiliun Nisa , Folkert Michael Ryan 
Published: February 2017

71 Background: Outcome for patients with malignant biliary obstruction is poor. While endoscopic or percutaneous procedures provide palliative benefit, stents often occlude or migrate, and drains frequently fail requiring repeat procedures in medically fragile patients. As part of a multidisciplinary effort to improve outcomes in this population, we undertook an investigation to determine rates of stent and drain failure and morbidity to identify areas of potential improvement. Methods: After Institutional Review Board approval, retrospective review of all cancer registry patients undergoing percutaneous or endoscopic intervention for biliary obstruction from 1/2004-10/2014 and billing reports from 11/2012-10/2014 identified 230 patients. Cases of biliary obstruction due to malignancy requiring intervention were selected, resulting in 94 evaluable patients. Charts were reviewed to determine dates and cause for stent and/or drain replacement and morbidity. Results: Of 94 analyzable patients, median age was 60 years and 49 were male (52%). Malignant cause of obstruction was gastric/colorectal in 16 (17%), biliary in 37 (39%), hepatocellular in 7 (7%), and pancreatic in 34 (36%). Stenting was part of the initial procedure in 47 (50%), and drain placement in 49 (52%). Ultimately 60 (64%) patients underwent stent procedures and 82 (87%) patients required drains. Of the stented patients, 27 (45%) required repeat stenting, and 13 (22%) required > 1 stent replacement. Of the patients who underwent drainage procedures, 68 (83%) required repeat drainage, and 52 (63%) required > 1 repeat drainage procedure. Cholangitis was observed following stent in 5 (5%) of patients, 60% in patients undergoing > 1 stent procedures. Median survival after initial procedure was 12 months; for patients requiring repeat procedures, median survival was 4.5 months. Conclusions: Malignant biliary obstruction is a morbid disease with high rates of reocclusion requiring repeat procedures, which may negatively impact outcome and increase healthcare cost. Efforts to reduce the rates of repeat procedures are critical to address this clinical need.
Outpatient palliative care needs of metastatic cancer patients treated with radiation therapy.
Authors: Rich Shayna Eliana , Castagno Jacqueline , Beaulieu Rebecca , Yeung Anamaria R 
Published: February 2017

73 Background: It is unclear how frequently patients with metastatic cancer treated with radiation therapy have unmet physical, psychological, spiritual, and practical needs of patients. This study aims to determine the level of support needed to meet this burden. Methods: We performed a telephone survey to evaluate the unmet needs of living patients with stage IV metastatic cancer treated with radiation therapy at a single institution in the priot six months. Data were collected using the Palliative care Outcome Scale, a validated 12-question survey about unmet patient needs, and its associated symptom scale. We examined patient treatment history by reviewing medical records. Among 87 eligible patients treated, 45 had died, 19 could not be reached, and two declined participation. Thus, 21 patients were included in the analysis. Results: Most frequent diagnoses were lung (24%; 5/21) or colorectal cancer (19%; 4/21). Most patients’ recent radiation course had palliative intent (62%; 13/21), but eight had received ablative radiation. No patients were undergoing radiation treatment when the survey was administered, and 57% (12/21) were receiving chemotherapy. Despite most patients seeing a physician within 2 weeks of the survey (median 1.7 weeks; range 0-11.4 weeks), most patients reported pain (67%) and anxiety (57%), and about 50% reported these issues as moderate or worse. At least one-third of patients reported having each need unmet. Patients complained of a median of five symptoms, with 57% of patients reporting any symptom severe. Patients on chemotherapy (n = 12) reported more symptoms and increased symptom severity, but 44% of patients reported moderate pain even among those not undergoing any therapy. Conclusions: Patients with metastatic cancer recently treated with radiation therapy continue to have substantial needs that are often not being met by standard oncologic care, despite recent visits with physicians. Although many of these patients are receiving chemotherapy and may be identified for palliative care programs through the medical oncology service, radiation oncology clinics should also routinely integrate quality palliative care for patients with metastatic cancer.
Symptom burden and palliative care for patients with multiple myeloma: Cancer Experience Registry findings.
Authors: Buzaglo Joanne S. , Miller Melissa F , Karten Clare , Longacre Margaret , LeBlanc Thomas William 
Published: February 2017

81 Background: Multiple myeloma (MM) patients are living longer with treatment advances yet remain challenged by complications and adverse treatment effects. Concurrent oncology/palliative care can improve symptom burden and quality of life for cancer patients, but the benefits of concurrent care for the MM symptom burden is not well described. Methods: From July 2013-2014, the Cancer Support Community (CSC) registered 495 MM patients to the Cancer Experience Registry: MM, an online initiative to study and raise awareness about MM’s psychosocial impact. Registrants were recruited through an outreach program including the CSC and The Leukemia & Lymphoma Society networks of communities and resources. 331 US-based registrants completed surveys about their MM history, treatment, and symptoms. Results: Median respondent age was 64 years; 54% were female, 87% Caucasian. Median time since diagnosis was 4.5 years, and 40% reported experiencing a relapse. Several symptoms interfered (quite a bit or very much) with respondents’ daily life: fatigue (40%), bone pain (22%), peripheral neuropathy (22%) sleep disturbance (21%), GI toxicity (16%), and mood swings (10%). The daily effects of fatigue, pain, sleep disturbance and mood swings were associated (p < 0.05) with distress. 36% did not report all symptoms and side effects (SEs) to their health care team (HCT). The most common reason was “I don’t think anything can be done about these problems.” More than half (58%) reported sleep disturbances related to steroids, and 46% experienced weight gain, 41% mood swings, and 39% edema. One-third (34%) reported their HCT never told them steroids could cause this. 85% felt their HCT prepared them (somewhat, quite a bit, or very much) to manage SEs of MM treatment, yet half (50%) felt little or no control over the physical SEs of MM and its treatment. Conclusions: Patients with MM experience significant symptom burden that interferes with daily living but underreport symptoms to the HCT. Many symptoms are amenable to interventions by palliative care specialists, which may improve MM patients’ quality of life. These findings suggest the need for more integration of palliative care services with oncology and other care for MM patients.
A web-based program to engage informal caregivers to support patients through chemotherapy.
Authors: Silveira Maria , Given CW , Sikorskii Alla , Given Barbara Ann , Cease Kemp Bailey , Piette John D 
Published: February 2017

90 Background: Most interventions to improve cancer symptoms rely on patient self-management, which can be challenging for some. "Cancer CarePartners" is a system designed to engage informal caregivers to support patients' quality of life as they receive chemotherapy. The system provides weekly, automated telephonic symptom assessment to patients, and symptom alerts plus tailored advice to their caregivers. We conducted a randomized control trial to test the efficacy of this program in controlling symptoms and improving adherence to chemotherapy. Methods: Consenting patients with solid tumors undergoing chemotherapy that reported any symptom at ³3 (out of 10) and had a consenting caregiver were randomly assigned to 10 w of either Cancer CarePartners or an attention control. Arms were balanced for lung cancer and caregiver type. Subjects were surveyed at 0, 10, and 14 weeks; charts were reviewed at 14 weeks. We tracked patient and caregiver use of the system. Results: 834 patients were referred to the study and 371 (45%) met eligibility criteria. Among the 151 (41%) patients who consented, 91% entered the study and 82% completed the trial. Patients completed assessments for most weeks on study (mean 7.7 intervention vs. 8.3 control). Intervention caregivers logged into the Website an average of 4.1 times over 10 weeks (range 0-10). At 10 weeks, intervention patients experienced lower summed symptom severity than controls (mean 19.5 vs. 23.2), but this was not statistically significant after adjusting for baseline symptoms (P = 0.107). They also experienced fewer inpatient stays (mean 0.19 vs. 0.34, P = 0.1814) and phone calls with providers (mean 0.46 vs. 0.62, P = 0.3019) than controls did. They received more chemotherapy (# agents per cycle 3.6 vs. 3.1 P = 0.0395; # agents per infusion 2.2 vs. 2.0 P = 0.0054). Intervention caregivers reported less depression (CESD Coef -1.08, P = 0.094, 95% CI -2.35 to 0.19), and similar burden as controls. Conclusions: Cancer CarePartners enhances caregiver support for patients and improves their symptom management and adherence with chemotherapy as a result, while adding little burden to the caregiver. One limitation of the study is that recruitment was less than expected. Clinical trial information: IIR 08-309.
Understanding causes of distress in women with gynecologic cancer.
Authors: Bevis Kerri S. , Kvale Elizabeth Ann , Rocque Gabrielle , Cantuaria Guilherme Henrique , Scalici Jennifer , Rocconi Rodney Paul , Finan Michael , Acemgil Aras , Li Yufeng , Taylor Richard A. , Demark-Wahnefried Wendy , Kenzik Kelly , Meneses Karen , Martin Michelle , Fouad Mona N. , Partridge Edward E. , Pisu Maria 
Published: February 2017

94 Background: Lay patient navigators can screen patients using a distress tool (DT) to identify and address multiple patient concerns. Patient-reported distress can be used to characterize the needs of patients with ovarian, endometrial, and cervical cancer through all phases of care from initial diagnosis through active treatment and into survivorship. Methods: The Patient Care Connect Program (PCCP) includes 12 cancer centers throughout Alabama, Mississippi, Georgia, Florida, and Tennessee and navigates Medicare beneficiaries with cancer. Within the PCCP, navigators documented distress levels, causes of distress, and requests for intervention. Distress screening results were used to describe needs of patients with gynecologic malignancies and to assess effective resolution of distress. Results: Initial DT results were collected on 360 patients with gynecologic cancers: 206 (57%) ovarian, 111 (31%) endometrial, and 43 (12%) cervical cancers. Fifty-six (16%) were African American. Twenty-four percent of patients reported a distress score ≥ 4 and 4% reported scores ≥8. Physical symptoms most frequently caused distress (44%) particularly fatigue, pain, and neuropathy. Practical problems (11%), informational needs (16%) and emotional issues (19%) were also common. Patients were most likely to request assistance with transportation (63%), financial/insurance issues (77%), and nutritional concerns (75%). Lay navigators were able to address these concerns in 92% of patients. Conclusions: Gynecologic cancer patients report diverse sources of distress extending beyond symptom management. By administering DTs, patient navigators may effectively facilitate resolution of patient identified distress. The project described was supported by Grant Number 1C1CMS331023 from the Department of Health and Human Services, Centers for Medicare & Medicaid Services. The contents of this abstract are solely the responsibility of the authors and do not necessarily represent the official views of the U.S. Department of Health and Human Services or any of its agencies.
Pruritus as an unmet palliative care need in cancer patients: A retrospective cohort study of a Duke patient-reported outcomes database.
Authors: Hudson Kathryn Elizabeth , Wolf Steven Paul , Pupa Mary Ruth , King Danielle Grace , Locke Susan C. , Abernethy Amy P , LeBlanc Thomas William 
Published: February 2017

97 Background: For cancer patients, the impact of pruritus is not well known, and may be increasing in incidence and severity for those receiving targeted agents. We aimed to describe pruritus in patients with solid tumors, assessing the incidence, pattern, treatments, and associations with cancer types and therapies. Methods: From 2009-2011, patients seen in the Duke Cancer Institute solid tumor clinics directly reported their symptoms on electronic tablets as part of routine care, using Patient Care Monitor 2.0. Of the resulting 17,338 encounters, >1,000 patients reported moderate-severe itching (score of >3 out of 10). The analysis cohort included 215 patients who reported severe itching (>6 out of 10) on at least one visit (total visits = 536). We reviewed charts to abstract demographics, diagnosis, stage, cancer therapy, comorbidities, anti-pruritus therapy, and provider response, and applied descriptive statistics and chi-square analyses. Results: Most patients had advanced disease (56% stage IV), and had breast (36%), lung (23%), kidney (8%), colorectal (6%), or prostate cancer (5%). Thirty percent were not on active therapy, 27% were receiving a targeted therapy, 29% were receiving cytotoxic chemotherapy, and 14% were receiving both. Pruritus persisted in 56% of patients, and resolved but recurred in 10%. Patients receiving chemotherapy were more likely to have severe rather than moderate pruritus (p 0.01), while those receiving targeted drugs were more likely to have persistent pruritus (p 0.03). Potentially high-risk targeted therapies including EGFR inhibitors, multi-kinase inhibitors, and mTOR inhibitors were not associated with severity or persistence of pruritus. Only 20% of patients were receiving an anti-pruritus treatment. Clinicians documented discussing pruritus in just 28% of cases, and addressed it directly only 10% of the time. Only 5% of patients were started on a new anti-pruritus treatment. Conclusions: Pruritus is common among patients with advanced cancer, and occurs across a range of cancer types and treatments. Pruritus is frequently not recognized or addressed by clinicians, and appears to be an unmet palliative care need in oncology.
Evaluation of α-1-acid glycoprotein as a prognostic factor of survival in patients with stage II-III esophageal carcinoma treated with neoadjuvant docetaxel, cisplatin, and fluorouracil chemotherapy followed by surgery.
Authors: Sasaki Yusuke , Kato Ken , Furuta Koh , Takahashi Naoki , Shoji Hirokazu , Honma Yoshitaka , Iwasa Satoru , Okita Natsuko T. , Takashima Atsuo , Hamaguchi Tetsuya , Yamada Yasuhide , Boku Narikazu 
Published: February 2017

100 Background: Serum α-1-acid glycoprotein (AAG) level was an independent predictor of response and a prognostic factor of survival in patients with non-small cell lung cancer treated with docetaxel chemotherapy. However, it has not been determined whether AAG is associated with the outcomes of esophageal cancer patients who have been treated with a combination of docetaxel, cisplatin and 5-fluorouracil (DCF) as neoadjuvant therapy. Methods: This retrospective study included a cohort of 39 patients with clinical stage II/III esophageal cancer, based on the International Union Against Cancer TNM classification system 7th edition, who were treated with neoadjuvant DCF followed by surgery. DCF consisted of docetaxel (70mg/m2) and cisplatin (70mg/m2) on day 1, and continuous infusion of 5-fluorouracil (750mg/m2/day) on days 1-5, with this regimen repeated every 3 weeks up to three cycles. Patients were divided into groups by median value of baseline AAG levels. Patient characteristics, preoperative clinical stage, chemotherapy effect, and survival were compared between the high and low AAG groups. Results: The clinical stage IIA, IIB, IIIA, IIIB and IIIC were 4, 4, 14, 17 and 0, respectively. The completion rate of three cycles of chemotherapy was 76.9% (30/39). All patients underwent surgery and the R0 resection rate was 97.4% (38/39). The best overall response rate of DCF was 48.7% with a pathological complete response of 5.1%. The 2-year progression-free survival and overall survival (OS) rates were 60.5% and 76.9%, respectively. The median serum AAG was 95 g/L, ranging from 57 to 228 g/L. A trend of lower response rate (35.0% vs. 57.9%; P = 0.20) and shorter OS (median not reached; hazard ratio [HR] 2.08; P = 0.24) was observed in patients with a high AAG level (AAG > 95 g/L) compared with a low AAG level (AAG ≦ 95 g/L). Multivariate analysis showed an AAG level hazard ratio of 1.60 (P = 0.59) for OS. Conclusions: There was a trend toward improved response and survival with low serum AAG level, for patients with esophageal cancer who received neoadjuvant DCF chemotherapy.
The optimal length of the proximal resection margin in patients with proximal gastric adenocarcinoma: A multi-institutional study of the U.S. Gastric Cancer Collaborative.
Authors: Postlewait Lauren McLendon , Squires Malcolm Hart , Kooby David A. , Poultsides George A. , Weber Sharon M. , Bloomston Mark , Fields Ryan C. , Pawlik Timothy M. , Votanopoulos Konstantinos Ioannis , Schmidt Carl Richard , Ejaz Aslam , Acher Alexandra W. , Worhunsky David J. , Saunders Neil , Swords Doug S. , Jin Linda X. , Cho Clifford Suhyun , Cardona Kenneth , Staley Charles A. , Maithel Shishir Kumar 
Published: February 2017

108 Background: A 5cm margin is advocated for distal gastric cancers. The optimal length of the proximal resection margin (PM) for proximal (GEJ Siewert II and III, cardia, and fundus) gastric adenocarcinoma (GAC) is not established. Methods: Patients who underwent curative intent abdominal-approach resection for proximal GAC from 2000-2012 at 7 academic US institutions were included. Patients with positive distal margins were excluded. PM length was analyzed by 0.5cm increments and was also dichotomized at the mean and median value. Primary endpoints were local recurrence (LR), recurrence-free survival (RFS) and overall survival (OS). Results: Out of 965 patients, 211 had proximal GAC, and 162 had data available on PM length. 151 patients had negative microscopic margins with a mean value of 2.6cm and a median of 1.7cm (range 0.1-15cm). When PM length was sequentially dichotomized and analyzed at 0.5cm increments (0.5-6.5cm), a greater margin distance for each analysis was not associated with LR, RFS, or OS. Similarly, a PM distance greater than the mean or median value was not associated with LR, RFS, or OS. 11 patients had a positive PM (R1), which was associated with higher N-stage (N3: 73% vs 26%; p=0.007) and increased LR (HR6.1; p=0.009). When accounting for other adverse prognostic factors (grade, lymphovascular invasion, tumor size, T-stage, and N-stage), a positive PM was not independently associated with LR. A positive PM was also not associated with decreased RFS or OS. Conclusions: For an abdominal-approach resection of proximal gastric adenocarcinoma, the length of the proximal margin is not associated with local recurrence, recurrence-free survival, or overall survival. A positive microscopic margin is associated with advanced N-stage but is not independently associated with recurrence or survival. When performing an abdominal-approach resection of proximal gastric adenocarcinoma, a grossly negative proximal margin is sufficient. Efforts to achieve a specific margin distance, especially if it necessitates an esophagectomy, should be abandoned.