bluuebunny/crossref_metadata_2025_split huggingface dataset:
Family caregiver grief and depression outcomes from the ENABLE III randomized controlled trial.
Authors: Dionne-Odom J Nicholas , Azuero Andres , Lyons Kathleen , Hull Jay , Tosteson Tor , Li Zhongze , Bakitas Marie 
Published: February 2017

48 Background: Little is known whether early palliative care (PC) support for family caregivers (FCGs) impacts grief and depression after care recipients die. We conducted a randomized controlled trial (RCT) of a nurse-led, phone-based concurrent PC intervention for FCGs delivered at the time of care recipients’ advanced cancer diagnosis (early group) or 12 weeks later (delayed group). We hypothesized that grief and depression scores would be lower for early compared to delayed group FCGs. Methods: Early vs. delayed RCT (10/2010-9/2013) of 123 FCGs of community dwelling persons with advanced cancer in a rural, New Hampshire NCI-designated comprehensive cancer center and affiliated outreach clinics and a Vermont VA medical center receiving a multicomponent intervention (ENABLE [Educate, Nurture, Advise, Before Life Ends]) consisting of 3 weekly sessions, monthly follow-up, and a bereavement call. FCGs of persons dying during the study period completed the Center for Epidemiological Study-Depression scale (CESD) and the Prigerson Inventory of Complicated Grief-Short Form (PG13) 8-12 weeks after care recipients’ deaths. Generalized estimating equations were used to compute group means, standard deviations, and between-group effect size differences. Results: For care recipients who died (n = 70), 44 FCGs (early: n = 19; delayed: n = 25) completed after-death questionnaires. Mean depression scores (CESD) for the early group was 14.6 (SD = 10.7) and for the delayed group was 17.6 (SD = 11.8). Mean grief scores (PG13) for the early group was 22.7 (SD = 4.9) and for the delayed group was 24.9 (SD = 6.9). Between-group effect size differences were not statistically significant (CESD: d = -.27, p = .38; PG13: d = -.36, p = .24). Conclusions: Though statistically insignificant, the magnitude of the observed between-group differences for depression was small and for grief was medium. Considering the small sample size and the delayed group’s mean depression score surpassing the clinical cutoff (CESD score > 16), the clinical relevance of these findings cannot be ruled out. Future upstream FCG PC interventions initiated long before end of life should continue to examine intervention effects on FCG after-death outcomes. Clinical trial information: NCT01245621.
Differences in palliative care needs among cancer survivors in an inner city academic facility versus a suburban community facility.
Authors: Lutz Alison , Regn Rachel , Robinson William , Robinson William R. 
Published: February 2017

61 Background: To determine differences in palliative care (PC) needs in newly diagnosed cancer patients from an inner-city academic facility compared to a suburban, community facility. Also, to identify ways to improve PC for cancer patients in these locations. Methods: 270 subjects with cancer were prospectively identified, 85 from an inner city academic facility (Site A), and 185 from a suburban community facility in the same metropolitan area. (Site B) All patients received treatment from board-certified oncologists. Master’s level Social Workers asked all subjects to complete a standardized, validated questionnaire to determine their palliative care needs prior to treatment. Completed questionnaires were collected and data was depersonalized and analyzed by the authors. Statistical differences were assessed using standard methods. Results: Site A patients were younger (56.3 vs 61.5years) less likely to be caucasian (35/85, 41.2% vs 114/185, 61.6%) and less likely to have private insurance (28/85, 32.9% vs 187/185, 47%). Site B patients were more likely to express a fear of pain, (112/185, 60.5% vs 28/85,32.9%) dying, (112/185, 60.5% vs 18/85, 21.2%) being alone, (112/185(60.5% vs 15/85, 17.7%) or nausea (117/185, 63.2% vs 10/85, 11.8%). Site A patients were more likely to express fear of not having transportation, (35/85, 41.2% vs 42/185, 22.1%) inability to pay for prescriptions, (28/85, 32.9% vs 40/185, 21.6%) or child care (13/85, 15.3% vs 9/185, 4.9%). All differences were significant at a p < 0.05. Conclusions: There are major differences in the PC needs of patients presenting to an inner-city academic vs suburban community facility. To be most effective, PC programs must be tailored to the community. Interventions proposed for the suburban community facility include early access to: 1) grief counseling, 2) support groups, 3) Nurse-Navigators. Interventions proposed for the inner city academic facility include early access to: 1) Medication cost assistance programs (local philanthropies, facility-based pharmacy discounts) 2) travel services (cab vouchers, coordination with public transportation schedules) 3) on-site child care facilities.
An international collaborative design of clinical nursing practice guidelines for patients with cholangiocarcinoma.
Authors: Acquisto Susan , Iyer Renuka V. , Driskill Karen M , Pinheiro Natasha , Weatherly Jacqueline , Musto Kaitlyn R , Lowitzer Heidi , McCallum Lynne , Drapek Lorraine 
Published: February 2017

65 Background: Cholangiocarcinoma (CC) accounts for approximately 3% of all gastrointestinal cancers and have a poor incident to mortality rate. The incidence in the United States (US) is 2,000-3,000 cases annually, with this rate steadily increasing during the last twenty years; this trend is not solely observed in US but also seen in Europe, Australia and Japan. The highest incidence is seen in Southeast Asia due to parasitic infection. CC presents many challenges to healthcare professionals due to the anatomic nature of CC (Lowe et al, 2015). The worldwide increase in incidence of CC is indication for the essential development of nursing practice guidelines underpinned by expert evidence and knowledge and regarding the key aspects of care. Methods: A collaboration of nursing professionals representing major cancer research institutions from around the country and the United Kingdom worked together to identify key aspects of care, the aim being to develop Clinical Nursing Practice Guidelines. The process included an exhaustive literature review using Pubmed, Uptodate, Medline, and CINAHL databases; submission of respective institutional practices; group consensus on guideline content, evidence-based scoring assignment and approval by the Cholangiocarcinoma Medical Advisory Board. Results: The guidelines developed include the care of the patient: (1) with external biliary drains and internal bile duct stents, (2) with intractable nausea and vomiting resulting from disease process, (3) with fatigue resulting from disease process, (4) undergoing chemotherapy, (5) undergoing photon radiation, (6) undergoing radiation on a clinical trial, and (7) preparing for liver transplantation. The purpose of the guidelines are to advance the scientific knowledge of the symptoms experienced, quality of life of patients with CCA, establish standards in patient care, and improve quality of care and satisfaction for patients diagnosed with CC. Conclusions: Creation of evidence-based guidelines will provide a springboard for expanded competent knowledge and a model to test for improvement in the care and quality of life of the patient with CC.
A randomized controlled trial of a cardiopulmonary resuscitation (CPR) video decision support tool for seriously ill hospitalized patients with advanced cancer.
Authors: El-Jawahri Areej , Temel Jennifer S. , Ramchandran Kavitha , Jackson Vicki A. , Chang Yuchiao , Walker-Corkery Elizabeth , Mann Eileen , Volandes Angelo E. 
Published: February 2017

7 Background: Discussing CPR preferences with patients with advanced cancer who are hospitalized is a critical component of end-of-life decision making. However, these discussions are challenging and often avoided by clinicians. We examined the impact of a CPR video decision tool on patients’ choices and knowledge about CPR, and their comfort with watching the video. Methods: We conducted a multi-center randomized controlled trial of 116 patients with advanced cancer hospitalized at two academic oncology centers. We randomized patients to either a 3-minute video describing CPR (n = 52) or standard-oncology care (n = 64). The primary outcome was participants’ preferences for CPR (immediately after viewing the video in the intervention arm). Secondary outcomes included patients’ knowledge (using 5-item questionnaire with higher score reflects greater knowledge), and intervention participants’ comfort with watching the video. Results: The mean age was 66 years (SD = 12); 50% were women, 84% were white, and 48% had lung or gastrointestinal cancer. Only 47% of study participants reported having a discussion about their CPR preferences at the time of admission to the hospital. At baseline, there were no differences in patients’ preferences for not wanting CPR between the intervention and control arms (63% vs. 58%, P = 0.79). After the intervention, participants randomized to the video were more likely not to want CPR (81% vs. 58%, P = 0.03) and were more knowledgeable (mean knowledge score 4.3 vs. 3.2, P < 0.0001) versus control participants. In the intervention arm, 81% of participants found the video helpful, and 94% felt comfortable watching it and would recommend it to others. Conclusions: Seriously ill hospitalized patients with advanced cancer who watched a CPR video decision support tool were more likely not to want CPR and were better informed about their options. Participants reported feeling comfortable watching the video and would recommend it to others facing similar decisions. Video decision support tools can facilitate end-of-life decision-making for hospitalized patients with advanced cancer. Clinical trial information: NCT01527331.
Validation of the Spanish version of the QODD questionnaire (QODDq-ESP) in a home-based cancer palliative care program and development of the QODDq-ESP-12.
Authors: Perez-Cruz Pedro Emilio , Padilla Pérez Oslando , Bonati Pilar , Thomsen Parisi Oliva , Tupper Satt Laura , Gonzalez Otaiza Marcela , Ceballos Yanez Diego , Maldonado Morgado Armando 
Published: February 2017

70 Background: Improving quality of death (QOD) is a key goal in palliative care. No instruments to measure QOD have been validated in Spanish. The goal of this study was to validate the Spanish version of the quality of death and dying questionnaire (QODD) and to develop a shortened version of this instrument suitable to be completed by phone interview. Methods: Translation/back-translation and adaptation of the QODD was performed following established standards. One question was removed due to cultural inadequacy. We enrolled caregivers (CGs) of consecutive deceased cancer patients from a single palliative care clinic in Santiago, Chile. CGs were contacted by phone between 4 and 12 weeks after patients’ death. Participating CGs completed the adapted QODD (QODD-ESP) by phone interview. A global rating question assessing quality of life (QOL) during the last week of life was included. A shortened version of the QODD (QODD-ESP-12) based on the model by Downey et al. (J Pain Sympt Manage 2010;39) was created. Measures of reliability (Cronbach-alpha), convergent validity (correlation with global rating question) and construct validity (factorial analysis [FA]) were estimated for both versions of the instrument. Results: 150 (50%) out of 302 CGs completed the QODD-ESP. Patients mean (standard deviation [SD]) age was 67 (14), 71 (47%) female and 131 (87%) died at home. CGs mean (SD) age was 51 (13), 128 (85%) female. Mean QODD-ESP score was 69 (range 35-96) with an alpha = .829. Correlation with last week QOL was .434 (p < .01). Kaiser-Meyer-Olkin measure of sampling adequacy was .585, not supporting the existence of a unique underlying construct. Mean QODD-ESP-12 score was 69 (range 31-97) with a alpha = .728. Correlation with last week QOL was .306 (p < .01). Confirmatory FA of QODD-ESP-12 showed that data fitted well Downey’s model (Chi2 4.85 (60), p = .311 Comparative Fit ndex = .98; Tuker-Lewis Index = .977 and root mean square error of approximation (RMSEA) = .023 (CI: 0-.056). Conclusions: QODD-ESP-12 is a reliable and valid instrument with good psychometric properties and can be used to assess QOD in a Spanish speaking cancer palliative care population by phone interview.
Patient-reported distress symptoms in patients undergoing palliative radiotherapy.
Authors: Single Megan , Hollant Laeticia , Gaines Katherine , Smart Bridget , Habboush Jacob , Biers Heather , Day Atiya , Miller Robert Clell , Vallow Laura , Tzou Katherine S. 
Published: February 2017

75 Background: The focus of palliative radiotherapy (RT) is on improving quality of life (QOL) for patients with serious illnesses by eliminating or decreasing physical symptoms. The importance of assessing distress levels in palliative care patients is recognized due to the relevance of QOL, as treatment is given to provide symptom-relief rather than curative results. We sought to identify the most common causes of patient reported distress during palliative RT. Methods: Retrospective review was performed for patients who received palliative RT from 11/1/2012 to 6/4/2015 for various types of metastatic cancer at our institution. All patients completed a Patient Reported Distress (PRD) questionnaire with 30 specific questions and an overall distress thermometer prior to beginning treatment. The PRD survey quantified 30 areas of current concern ranging in patient-reported values from 1 to 5 in addition to a linear analog measure from 0 to 10 of overall reported distress in the last month. Results: Completed PRD surveys were available for a total of 297 patients, 149 (50.2%) female and 148 (49.8%) male. All patients were undergoing external beam radiation therapy for treatment of metastatic disease. 49 (16%) received chemotherapy and 46 (9%) underwent surgery. Overall distress ranged from 0 to 10, with a median of 5.0. The mean distress scores for the top five concerns ranged from 1.4 to 2.7. Top distresses were “Fatigue” (2.7), “Pain that affects daily functioning” (2.6), “How will I feel during treatment” (2.5), “Sleep difficulties” (2.4), and “Out of pocket medical costs” (2.3). Least troubling symptoms were “Transportation” (1.4), “A loved one relying on me for their physical care” (1.5), “My job” (1.5), “Housing during treatment” (1.5), “Spirituality” (1.5), and “Anger” (1.5). Conclusions: Patients demonstrated concern for distress related to interruption of activities of normal life, such as tiredness and insomnia, pain, and overall burdens from treatment. Medical costs were also a major concern. Importantly, housing and transportation were not issues in the current study but could be of concern in other regions. Providers should be aware that patients’ primary concerns may not be directly related to the symptom being palliated.
Patients’ perception of long-term, low-molecular weight heparins for cancer-associated thrombosis (CAT): Treatment expectations, convenience, and satisfaction related to patient profile.
Authors: Cajfinger Francis , Farge-Bancel Dominique , Falvo Nicolas , Sevestre Marie-Antoinette , Lamblin Anne ,   On behalf of TROPIQUE investigators
Published: February 2017

88 Background: In the TROPIQUE study CAT pts had high expectations for anticoagulant treatment & long-term LMWH was perceived as convenient with high degree of treatment satisfaction. In this study, using the Perception of Anti-Coagulant Treatment Questionnaires (PACT-Q), we assessed the inpact of patient profile on treatment expectations, convenience and satisfaction. Methods: PACT-Q (1&2) were proposed on a voluntarily basis to cancer pts recently diagnosed with symptomatic venous thromboembolism; the global mean scores±SD was correlated to pts characteristics. Results: 269 PACT-Q1 & 139 PACT-Q2 were analysed &135 pts done both of them. In all pts, the highest mean scores were for expectations of symptom relief (4.22±0.9), confidence in preventing clots (3.98±1.04) & importance of simplicity of use (3.94±0.75). For clot prevention men were more confident (4.06±0.81) vs women (3.85±0.88). Expectations of symptom relief was higher in women (4.07±0.98) vs men (3.89±1.09). Importance of ease of use was higher in treated pts (4.27±0.89) vs no therapy (4.00±0.99) & pts with age ≥ 49 (4.46±0.59) vs < 49 years (3.98±1.07). At the end of the study, PACT-Q2 answers showed, an Anticoagulant Treatment Satisfaction scores of 62.9±16.7. 67.2% of pts felt strongly reassured & 48.5% were satisfied with symptom decrease. 69.1% of pts were satisfied / very satisfied with their anticoagulant treatment. Treatment-related side effects were as expected (41.7%), better/much better than expected (45.5%). 80.6% of pts reported higher ease with tinzaparin and 76.2% with other LMWH. According to pts characteristics, satisfaction was higher in men (64.4±17.7) vs women (61.0±15.0), in non-metastatic (64.6±16.9) vs metastatic (61.1±16.2). ECOG (3-4) pts reported lower treatment convenience with higher satisfaction vs ECOG (0-1); 80.0% of ECOG (3-4) pts were satisfied/very satisfied with anticoagulant treatment. 70.0% of ECOG (1-0) patients stated symptom decrease & 80.0 % a feeling of reassurance. Conclusions: pt’s profile influenced positively the perception of long-term LMWH treatment but not the convenience & treatment satisfaction.
Starving for attention: Malnutrition screening in a community cancer center.
Authors: Sivendran Shanthi , Roda Patti I. , Sporay Jennifer , Guittar Ronald , Cox Christine , Newport Kristina Braine 
Published: February 2017

96 Background: It is estimated that 50% of cancer patients are at risk for malnutrition, causing physical and emotional distress that interferes with cancer treatment. Early detection and intervention may prevent severe malnutrition. Assessment and management of malnutrition are included in National Comprehensive Cancer Network (NCCN) guidelines but no specific recommendation regarding screening tool selection is provided. The Malnutrition Screening Tool (MST) is a short, easily administered screening tool, validated for identification of malnutrition in cancer patients. In this study, we describe the results of MST administration in a large community cancer institute. Methods: The MST was administered during all patient visits to our cancer institute in 2015. Patients scoring 2 or higher were identified as ‘at risk’ for malnutrition, resulting in electronic dietitian referral prompts. We retrospectively reviewed MST results from April through June 2015 and compared to dietitian referrals during the same period in 2014. At that time, dietitian consults were prompted by physician referral, patient request, or triggered by NCCN distress thermometer screen. Results: The MST identified 84% more patients in need of dietitian referral in 2015 compared to usual care in 2014. From April through June 2015, the MST was administered during 4082 discrete patient encounters. 6.7% of these visits resulted in MST score of 2 or greater for a total of 193 ‘at risk’ patients in need of referral to dietitian. Weight loss of 2 pounds or greater was reported by patients in 16% of encounters. Eating poorly because of a decreased appetite was reported by patients in 13% of the encounters. From April through June 2014, 105 patients were referred for dietitian consult, indicating the MST identified 88 more ‘at risk’ patients. Conclusions: The MST is a simple, valid tool for malnutrition screening in cancer patients that resulted in an 84% increase in identification of ‘at risk’ patients. This tool should be considered for standard malnutrition screening of cancer patients, to prompt referral for dietitian intervention.
Clinical activity of AMG 337, an oral MET kinase inhibitor, in adult patients (pts) with MET-amplified gastroesophageal junction (GEJ), gastric (G), or esophageal (E) cancer.
Authors: Kwak Eunice Lee , LoRusso Patricia , Hamid Omid , Janku Filip , Kittaneh Muaiad , Catenacci Daniel Virgil Thomas , Chan Emily , Bekaii-Saab Tanios S. , Amore Benny , Hwang Yuying C. , Tang Rui , Ngarmchamnanrith Gataree , Hong David S. 
Published: February 2017

1 Background: Dysregulation of the MET pathway can promote tumor growth and metastasis. AMG 337 is an investigational, oral MET kinase inhibitor that is being evaluated in a first-in-human study. Here we describe the clinical activity, safety, and tolerability of AMG 337 in ptswith MET-amplified GEJ, G, and E cancers. Methods: Key eligibility criteria: age ≥ 18 years, advanced solid tumors, measurable disease, ECOG ≤ 2, adequate organ function. AMG 337 was administered QD or BID. Starting dose was 25 mg, with planned dose escalation of 50–500 mg QD and 100–200 mg BID. Ptswith MET overexpression/amplification/mutation could enroll to the highest dose deemed safe at any time. Results: As of April 2014, 80 pts had received ≥ 1 dose of AMG 337. Median (range) age, 58 (19–79) years; men, 61%; ECOG ≤ 1, 96%. Of the 51 pts with pre- and post-central read data, 10 pts had MET-amplified GI cancers (all of which were GEJ, G, or E cancers). Responses in these pts are shown in the table. One pt had a complete response (duration 100 wks) and 4 pts had partial responses (durations up to 52 wks). The most common treatment-emergent AEs (in > 20% of all pts) were headache, nausea, fatigue, vomiting, and constipation. AEs and dose-limiting toxicities were reported previously (Hong et al., ASCO 2014). The AE profile of pts with GI cancers was comparable to that of all ptsenrolled in the study. QD maximum tolerated dose (MTD) is 300 mg; BID MTD has not been reached. Conclusions: Responses to AMG 337 were observed in a subset of pts with MET-amplified GI tumors. A dose-expansion phase will enroll up to 50 ptswith MET-amplified tumors at the MTD. Clinical trial information: NCT01253707. [Table: see text]