bluuebunny/crossref_metadata_2025_split huggingface dataset:
Incidence and costs of thromboembolic events in cancer patients: A study on four major cancer localization.
Authors: Borget Isabelle , Vainchtock Alexandre , Martelli Nicolas , Scotte Florian 
Published: February 2017

185 Background: Venous thromboembolic event (VTE) is a common complication for cancer patients, leading to hospitalizations that increase the burden of cancer management. Our study aimed to estimate the incidence and costs of hospitalizations for VTE, in French patients with breast cancer (BC), colon cancer (CC), lung cancer (LC) or prostate cancer (PC), four of the most frequent cancers in France. Methods: We used the French national hospital database (PMSI) to select new patients with BC, CC, LC or PC in 2010, who had at least one VTE-related hospitalization during the following two years. VTE-related stays and patients were identified using the disease-specific ICD-10 codes. Hospital costs were calculated over stays for which VTE was considered as primary/related diagnosis. Costs were estimated from the healthcare system perspective, using the French official tariffs. Results: Among 194,964 patients newly diagnosed in 2010 with BC, CC, LC or PC in 2010, 8,909 (4.6%) were hospitalized for a VTE or experienced VTE at hospital, representing, 12,880 hospital stays. During the two-year follow-up, 2,053 (23.0%) patients were re-hospitalized for a VTE recurrence, representing 3,969 stays (30.8% of admissions for VTE). For one patient with VTE who did not experience recurrence, the mean hospital cost over two years ranged from €3,302 to €3,674. This amount was dramatically increased for patients with recurrent VTE, as it ranged from €5,441 to €5,692 per patient. Hospitalizations for VTE associated with those 4 types of cancer only were responsible for an overall expenditure reaching €13.30 million over two years, including €1.82 million due to recurrent events. Conclusions: VTE-related cancer hospitalizations remain frequent and induce a notable cost. Prevention and management in respect to guidelines would be an efficient way to reduce the incidence of this complication and moderate its economic cost. [Table: see text]
Development of a mobile application (app) for improving symptoms and adherence to oral chemotherapy in patients with cancer.
Authors: Nisotel Lauren , Amoyal Nicole , Fishbein Joel , MacDonald James , Pirl William F. , Temel Jennifer S. , Lennes Inga Tolin , Safren Steven A. , Buzaglo Joanne S. , Jethwani Kamal , Greer Joseph A. 
Published: February 2017

189 Background: An advantage of oral chemotherapy is ease of administration, yet patients and family caregivers receive less support for adherence and monitoring of side effects. Effective interventions should support adherence to oral chemotherapy. We conducted qualitative interviews with patients, clinicians, and relevant stakeholders to inform the development of a proposed mobile app intervention to improve adherence and symptoms to oral chemotherapy. Methods: We conducted qualitative interviews and focus groups with multiple stakeholder groups (18 oncology physicians, 8 healthcare representatives, 8 cancer practice administrators, 18 patients and family members). Eligible patients had a diagnosis of cancer, a prescription for oral chemotherapy, cancer care at the MGH Cancer Center, and access to a smart phone. Stakeholders and clinicians evaluated the study approach, patient engagement, and intervention implementation. Patients reviewed wireframes of the mobile app to evaluate the components, usability, feasibility, and acceptability. Results: The app features include a treatment plan, medication reminders, symptom reporting, and cancer-specific resources. The themes from the qualitative interviews suggest that this mobile app would be helpful in improving adherence to oral chemotherapy and symptom management. Patients reported the wireframes to be acceptable and potentially user-friendly. Clinicians found that ongoing symptom reports would be helpful for proactively managing patients’ symptoms. Stakeholders recognized the importance of an app with functional tools to aid adherence and symptom management. All parties agreed that app features should remain simple, avoid undue burden, and thus enhance usability. Conclusions: Our findings suggest that a mobile app could be helpful for adherence and improving symptoms to oral chemotherapy in patients with cancer. Patients and clinicians rated the wireframe content favorably and commended the different features. We refined and finalized the mobile app based on feedback from the qualitative interviews. These findings support our plan to test the efficacy of this intervention in a randomized controlled trial. Clinical trial information: NCT02157519.
Personalized symptom goals in symptom assessment: A prospective multicenter study.
Authors: Hui David , Shamieh Omar M. , Paiva Carlos Eduardo , Perez-Cruz Pedro Emilio , Muckaden Mary Ann , Park Minjeong , Bruera Eduardo 
Published: February 2017

190 Background: PSG is a novel measure to assess treatment response in symptom management. In this multicenter prospective longitudinal observational study, we examined the PSG for 10 common symptoms in patients with advanced cancer, and identified the factors associated with PSG intensity and PSG response. Methods: We enrolled patients with advanced cancer seen at 5 outpatient palliative care clinics (USA, Jordan, Brazil, Chile and India). We assessed the intensity of 10 symptoms using the Edmonton Symptom Assessment Scale at first consultation visit and then a second visit 14-34 days later. We also assessed the PSG by asking patients “At what level would you feel comfortable with this symptom?” using the same 0-10 numeric rating scale for each symptom. Response was defined as symptom intensity ≤ PSG. We used multivariate logistic regression to determine factors associated with PSG intensity and PSG response. Results: 728 patients were enrolled from 5 palliative care clinics. The average age was 57 (range 19-85), 361 (50%) were female, and 29 (31%) were White. The medianPSG was 1/10 for nausea, 2/10 for depression, anxiety, drowsiness, well-being, dyspnea and sleep, and 3/10 for pain, fatigue, and appetite. In multivariate logistic regression, Asian ethnicity (odds ratio [OR] 2.4-8.2, P < 0.001), CAGE positivity (OR 1.7-2.3, P < 0.05) and higher baseline symptom intensity (ORs 1.08-1.15 per point, P < 0.03) were associated with PSG ≥ 2 for essentially all symptoms. At visit 2, 34%-73% of patients had a PSG response, which represents a significant improvement compared to the first visit (P < 0.05 except for depression, drowsiness and well-being). PSG response was associated with baseline PSG intensity (ORs 1.3-1.5 per point, P < 0.001) and ethnicity (P < 0.02) for physical symptoms, and male sex (ORs 1.45-1.65, P < 0.02) for psychological symptoms. Conclusions: PSG was 3 or lower for a majority of patients, and varied according to ethnicity, alcoholism and symptom intensity. PSG response allows clinicians and researchers to tailor treatment goals, while adjusting for individual differences in scale interpretation and factors associated with symptom response.
Effects of methylphenidate (MP) on symptom couplets associated with cancer-related fatigue (CRF) in patients with advanced cancer.
Authors: Yennu Sriram , Williams Janet L. , Park Minjeong , Liu Diane D , Bruera Eduardo 
Published: February 2017

191 Background: Psychostimulant clinical trials on CRF in pts with advanced cancer suggest mixed effects on CRF. The aim of this study was to determine the effects of MP and placebo (PL) on the pts with clinically significant CRF and associated symptoms such as depression, sedation, or depression and sedation (couplets). Methods: Secondary analysis of pts who received MP as a part of 3 prospective controlled clinical trials on MP for CRF. Pts were categorized one of 4 groups, fatigue+depression (FD), fatigue+ drowsiness (FDR), fatigue+drowsiness+depression (FDDR) or fatigue only (F), and outcomes were change in FACIT-F subscale and ESAS -fatigue scores at Day 8 of treatment with MP and PL. Repeated measures analysis was applied to assess the effects of treatment over time (Day8 – Day0) among the 4 groups on FACIT-F subscale and ESAS fatigue. Results: Of the 322 evaluable pts (34 FD, 100 FDR, 78 FDDR, 107F), at Day 8 there was a significant improvement in the ESAS fatigue in MP compared to PL groups [median (IQR)-2 (-4, -1) vs 2 (-3.5,0),p = 0.03, but the difference in the change of FACIT-F between the groups was not significant [median(IQR) 8(2,17) VS7(0,12), p = 0.09). Repeated measures analysis on FACIT-F with pairwise interactions(Time X Baseline Group, Time X Treatment) shows that regardless of treatment, the increase of FACIT-F from Day0 to Day8 was significantly different between FD and F (p = 0.001) and between FDDR and F (p = 0.03).However the change over time was not significantly different between two treatment groups (p = 0.23). Furthermore, the repeated measure analysis including three term interactions(Time X Treatment X Baseline Group) indicates no significant the treatment effect on FACIT-F over time is not significantly different among the four groups (p = 0.89). Similarly, there is no significant treatment effect in ESAS fatigue score over time among the four groups. Conclusions: Although there was a general improvement in CRF (FACIT-F) scores over time, there was no significant treatment effect on this improvement over time among F or FD, or FDR, or FDDR groups defined by fatigue/depression/sedation in the whole study population. Further studies are needed.
Wearable sensor-based balance training in older adult cancer patients with chemotherapy-induced neuropathy: A randomized controlled trial.
Authors: Schwenk Michael , Garland Linda L. , Grewal Gurtej Singh , Holloway Dustin , Muchna Amy , Mohler Jane , Najafi Bijan 
Published: February 2017

195 Background: Chemotherapy-induced peripheral neuropathy (CIPN) can affect lower extremity joint proprioception leading to balance deficits and increased fall risk. This study evaluated the effect of a sensor-based exercise program on improving postural control in cancer patients with CIPN. Methods: Twenty two cancer patients (Age 70.3±8.7 years) with objectively confirmed CIPN (vibration perception threshold test, VPT > 25 Volt) were randomized to twice weekly x 4 weeks sensor-based training including weight shifting and virtual obstacle crossing with real-time visual feedback of lower-extremities through wearable wireless sensors (intervention group, IG, n = 11) or no intervention (control group, CG, n = 11). Outcome measures included changes in sway of ankle, hip, and center of mass (CoM) in both medio-lateral (ML) and anterior-posterior (AP) directions during 30 second standing in feet closed position (both feet next to each other) with eyes open (EO) and eyes closed (EC), and semi-tandem position (big toe by arch of other foot) with EO, at baseline and post-intervention. All assessments were made using validated wearable sensors. Results: VPT score averaged 49.6 ± 26.7 Post intervention, sway of hip, ankle and CoM (ML) were significantly reduced in the IG compared to the CG during FC position (p = .010-.022). During the more challenging position of semi-tandem, all sway parameters except ankle were significantly reduced (p = .008-.039). Effect sizes were moderate-large (eta squared = .255-.388). Conclusions: This randomized controlled study using a novel wireless sensor-based training demonstrated improvements in balance in CIPN patients by measures of balance that have been related to fall risk. We speculate that the sensor-based training with real-time visual joint position feedback provided participants with enhanced information about joint movements and motor error in order to compensate for deteriorated/lost lower extremity joint proprioception from CIPN. This balance training system can be easily translated to an in-home setting and may decrease fall risk and thus improve cancer patients’ quality of life. Clinical trial information: NCT02043834.
Evaluation of hyponatraemia in lung cancer patients: A U.K. teaching hospital experience.
Authors: Jain Ankit , Jafri Mariam , Mascall Sophie , Alam Salma Moona , Thomas Rhian , Kendrick James , Thompson Joyce 
Published: February 2017

197 Background: Hyponatraemia, defined as a serum Na < 135mEq/L, is the commonest electrolyte abnormality in oncology practice. We describe the demographics, oncological management and response of hyponatraemia to oncological treatment modalities in our patient group. Methods: We retrospectively analysed serum sodium levels in lung cancer patients admitted to a teaching hospital in the UK between 2007 and 2013. Data was collected on baseline demographics, histology, tumour stage and grade of hyponatraemia. Mild hyponatraemia was defined as a serum sodium between 130-135mEq/L, moderate 125-129mEq/L and severe as < 124mEq/L. Results: 182 (108 male; 74 female) patients with lung cancer and documented hyponatraemia were hospitalised between 2007 and 2013. The median age of patients on admission was 69.2 years (range 33-92 years). 119(65%) had mild, 58(32%) moderate and 5(3%) severe hyponatraemia. 74(40%) were adenocarcinomas, 58(32%) squamous carcinomas, 43(24%)SCLC and 7(4%) had unspecified NSCLC. 89(49%) had metastatic disease on diagnosis. 18/43(42%)small-cell, 14/58(33%) squamous, 23/74 (31%)adenocarcinoma patients had moderate to severe hyponatraemia. 132(74%) of this cohort had active oncological treatment: 93(51%) chemotherapy, 25(14%) radiotherapy, 17(9%) surgery whilst 47(26%) had best supportive care. 28(15%) had a biochemical response to their treatment, 11(39%) of these patients were adenocarcinomas, 10(36%) squamous carcinomas and 7(25%) SCLC. Conclusions: Hyponatraemia in lung cancer patients is widely distributed in various age groups and histological subtypes. Among those admitted with hyponatraemia, severe cases were rare. Higher rates of SIADH are seen in SCLC than in any other malignancy and proportionately more SCLC patients had moderate - severe hyponatremia than NSCLC. Hyponatraemia responds to active oncological treatment including chemotherapy, radiotherapy and surgery. Although historically, hyponatraemia is considered a poor prognostic marker and has been associated with shorter survival duration, this should not preclude active oncological management. Further studies are needed to evaluate the prognostic value of hyponatraemia and its treatment in cancer patients.
Palliation of ulcerative breast lesions with radiation.
Authors: Vempati Prashant , Knoll Miriam , Dharmarajan Kavita Vyas , Green Sheryl , Tiersten Amy , Bakst Richard Lorne 
Published: February 2017

199 Background: Patients with advanced breast cancer may experience ulcerative breast lesions. Breast cancer with ulcerative lesions has been shown to severely affect a patient’s quality of life (QoL). The role of palliative radiation therapy (RT) in the management of ulcerative breast lesions needs to be further explored. Methods: IRB-approval was obtained to retrospectively review the radiation treatment records for all patients who underwent palliative RT for breast cancer at our urban academic medical center. A total of 13 patients were identified, and we herein report their demographics, treatment characteristics, and clinical outcomes. Results: The mean age of the patients receiving palliative RT for ulcerative breast cancer was 64 years. All patients had stage IV disease when they were evaluated for RT. All patients received prior systemic chemotherapy with a mean of four chemotherapeutic agents, the most common of which was Capecitabine. The mean radiation dose received for palliative RT was 27.54 Gy in 11 fractions with a median dose of 30 Gy in 15 fractions. Six (46%) of the patients received prior RT to the same breast, with a median dose of 59.5 Gy in 31 fractions. Among these six patients, the average interval between initial RT and ulcerative breast lesion was 69.5 months. The median overall survival in all patients since ulcerative breast lesion was 5 months and the mean survival did not differ between patients with previous history of RT and RT-naïve patients (4.50 vs. 4.57; p = 0.95). Six out of the 9 (69%) patients who received ≥ 30 Gy reported clinical improvement, whereas none of the 4 patients who received < 30 Gy reported any benefit. There were no radiation-associated toxicities reported by patients. Conclusions: These data suggest that palliative RT ( ≥ 30 Gy) is an efficacious treatment for ulcerative breast cancer with minimal toxicity. Prior RT should not be a contraindication as patients with previous history of RT have similar outcomes compared to RT-naïve patients.
Association between oncologists’ dispositional affect and depressive symptoms in their patients with metastatic cancer.
Authors: Pirl William F. , Lerner Jennifer , Eusebio Justin , Traeger Lara , Fields Lauren , El-Jawahri Areej , Greer Joseph A. , Temel Jennifer S. 
Published: February 2017

214 Background: While caring for patients with metastatic cancer can be emotional, relationships between the emotions of oncologists and their patients have not been examined. As patients and oncologists read emotional cues in encounters, emotions of one or both may impact the other. We explored associations between dispositional affect, tendencies to emotionally respond to situations in certain ways, in oncologists and depressive symptoms in their patients with newly diagnosed metastatic lung and gastrointestinal (GI) cancers. Methods: As part of an ongoing trial of early palliative care, participants were assessed at baseline for depressive symptoms (Patient Health Questionnaire-9, PHQ9) within 8 weeks of diagnosis with metastatic lung and GI cancers. Oncologists providing care for these patients completed the Positive and Negative Affect Scale (PANAS), a validated measure of dispositional affect with positive and negative dimensions. Associations between patient depressive symptoms and oncologists' positive and negative dispositional affect were tested with linear regression models. Results: Sixteen of the 18 oncologists with patients in the trial completed the PANAS. Among 323 participants with baseline assessments, 277 (86%) had oncologists who completed the PANAS. Mean age=64.6, 129 (46%) were female, 159 (57%) had GI and 118 (43%) lung cancer, and mean PHQ9 score=6.5. Positive and negative dispositional affect were not associated with oncologists’ sex, years from training, hours in clinic, and cancer specialization. Patient depressive symptoms were significantly higher if their oncologists reported greater negative dispositional affect (p=.04). The relationship remained significant adjusting for patient age, sex, cancer type, ECOG PS, smoking, and number of oncology visits (β=.13, t=2.1, p=.04). PHQ9 scores were not associated with oncologists’ positive dispositional affect. Conclusions: Depressive symptoms in patients with metastatic lung and GI cancers appear to be associated with their oncologists’ negative dispositional affect. Determining the direction of the association may lead to new ways of improving patients and/or oncologists moods.
Mobile application of cognitive behavioral therapy for anxiety and advanced cancer.
Authors: MacDonald James , Amoyal Nicole , Nisotel Lauren , Perez Giselle Katiria , Traeger Lara , Temel Jennifer S. , Pirl William F. , Safren Steven A. , Greer Joseph A. 
Published: February 2017

220 Background: We previously demonstrated the efficacy of a brief, in-person cognitive behavioral therapy (CBT) program for alleviating anxiety in patients with advanced cancer. The aim of the current study was to adapt this program to an interactive, patient-centered mobile tablet application (CBT app) for self-delivery, ideally to enhance dissemination and patient access to the CBT intervention. Methods: Development of the CBT app proceeded in two phases. First, we enrolled five patients with advanced cancer and anxiety (HADS-Anxiety subscale score ≥ 8) to review a preliminary CBT app prototype and to provide qualitative feedback regarding intervention acceptability and utility. Using content analysis of the recorded data, we identified key themes in patient feedback and refined the CBT app content and design accordingly. Finally, a multidisciplinary team of clinical researchers (n=7) specializing in healthcare technology, psychiatry, and psychology conducted an extensive iterative review process to vet and finalize the CBT app intervention. Results: Patients reported that the CBT app content was comprehensible, easily navigated, and helpful in addressing a breadth of concerns relevant to patients with anxiety and advanced cancer. Specifically, patients reported that case examples, tailored feedback, accessible interactive features, and content summaries were important for engagement with the program. The multidisciplinary study team used patient feedback to adapt the CBT app prototype to a tablet design consisting of six modules that teach skills for practicing relaxation, staying present-focused, coping with fears related to cancer, and pacing activities. To enhance patient engagement, features also included homework assignments, symptom distress tracking, and tailored algorithms and branching logic based on patient responses. Conclusions: Patient interviews confirmed acceptability of the CBT app content. Expert clinician feedback also supported the tablet design for self-administration of the intervention to reduce patient burden. We are currently conducting a randomized controlled trial to assess the efficacy of the CBT app for improving anxiety symptoms in patients with advanced cancer. Clinical trial information: NCT02286466.
Acceptability among advanced cancer patients of creating legacy teaching videos.
Authors: Makowski Suzana , Wachholtz Amy , Fitch Christina , Doering Alex , Tjia Jennifer 
Published: February 2017

232 Background: The beneficial effects of life story review and legacy activities on the mood and quality of life for adults with advanced illness is well described, including the creation of legacy videos for family gifting. It is unknown whether creating legacy videos with the intent of teaching future healthcare professionals about the “cancer patient” experience is acceptable, beneficial, or meaningful to patients. The study aim is to describe the acceptability and success of recruiting patients with advanced cancer to create teaching videos for healthcare professionals. Methods: Patients aged 18 and older were recruited from the outpatient oncology clinic, palliative medicine clinic, and inpatient service of an academic medical center in the Northeast. Eligibility included having a diagnosis of an unresectable advanced cancer, an ECOG score of 0-3, being English speaking, and not having active psychosis. Patients underwent in-person, digital video recorded interviews that followed a semi-structured interview guide. Interview questions addressed the lived experience of being a “cancer patient,” coping, and how the patient thought clinicians could provide better care to future patients. For each patient, we measured the Functional Assessment of Cancer Therapy - General (FACT-G), Hospital Anxiety and Depression Scale (HADS), Patient Dignity Inventory (PDI), Distress Thermometer, and study acceptability. Results: Recruitment is ongoing. To date, of 12 patients referred, 4 completed the video, and 3 completed the follow-up visit. On average, it takes six contact attempts (phone calls or text message threads) to schedule an appointment that resulted in a completed video. Each interview lasted about a 1-1.5 hours. Patients reported that they “really enjoyed the experience,” and “it had helped them process” their cancer experience. A common theme was the patient’s strong desire to help others by sharing their story. Conclusions: Patients with advanced cancer find recruitment and participation in an educationally-oriented legacy video project acceptable and potentially personally helpful.