bluuebunny/crossref_metadata_2025_split huggingface dataset:
Delirium assessment in patients with advanced cancer presenting to the emergency department of a comprehensive cancer center.
Authors: Elsayem Ahmed F. , Valentine Alan D. , Warneke Carla L. , Page Valda D , Bruera Eduardo , Yeung Sai-ching J. , Brock Patricia A , Silvestre Julio , Holmes Holly Michelle , Todd Knox H 
Published: February 2017

217 Background: The exact frequency of delirium among patients with advanced cancer presenting to emergency departments (EDs) is unknown. The purpose of this study is to determine the prevalence of delirium among patients with advanced cancer who present to the ED at MD Anderson Cancer Center. Methods: The exact frequency of delirium among patients with advanced cancer presenting to emergency departments (EDs) is unknown. The purpose of this study is to determine the prevalence of delirium among patients with advanced cancer who present to the ED at MD Anderson Cancer Center. Results: A total of 624 patients were screen for this study, and 243 patients were enrolled. The main reasons for exclusion were: 1) cancer was not advanced, 2) the patient had been in the ED for over 12 hours and 3) the patient was non-English speaking. The median age for all patients enrolled was 62 years (range 19 – 89 years), 167 (69%) were white, and 120(49.4) were female. CAM was positive in 22(9%) of patients. The median MDAS score of CAM positive patients was 14 (range 9 – 22 out of 30). Ten (10%)of 99 patients aged 65 and older were delirious as compared to 12 (8%) of 144 patients younger than 65 years (p = 0.6). Physician correctly predicted delirium in 13 patients (59%). Among the patients who were CAM positive 18 (82%) were admitted to the hospital as compared to 115 (52%) of patients without delirium (p = 0.012). Patients with delirium had higher hospital, and six months mortality rate. Conclusions: Delirium was identified in 9% of patients with advanced cancer visiting an ED, and is associated with more hospitalization and poor survival.
Depression and anxiety among family caregivers of patients with advanced cancer.
Authors: Nipp Ryan David , Fishbein Joel , El-Jawahri Areej , Pirl William F. , Moran Samantha M.C. , McCarty Caitlin , Eusebio Justin , Gallagher Emily R. , Park Elyse R. , Jackson Vicki A. , Greer Joseph A. , Temel Jennifer S. 
Published: February 2017

224 Background: Despite the important role family caregivers (CGs) play in the care of patients with cancer, little is known about their psychological distress. We sought to describe rates and correlates of depression and anxiety in CGs of patients with advanced cancer to determine those at greatest risk for psychological distress. Methods: As part of an ongoing trial of early palliative care, we are assessing baseline depression and anxiety in patients within 8 weeks of advanced lung or gastrointestinal cancer diagnosis and their CGs. We are administering the Hospital Anxiety and Depression Scale (HADS), with subscale scores >7 denoting clinically significant depression or anxiety. We are assessing patient coping styles with the Brief COPE. We used multiple logistic regression with purposeful selection of covariates to identify correlates of CG depression and anxiety. Results: Of 240 CGs (mean age=57 years), 156 (65%) were spouses/partners, 167 (70%) were female, and 131 (55%) were working. 37 (15%) and 102 (43%) CGs reported significant depression and anxiety, respectively. CG age, gender and employment status, as well as patients’ anxiety and lack of acceptance coping were associated with higher rates of CG depression. CG age, gender, marital status and education level, as well as patients’ anxiety and presence of brain metastases were associated with higher rates of CG anxiety. Conclusions: Younger, female CGs were at greatest risk of both depression and anxiety. Thus, this CG population should be monitored closely and referred for cancer center support services for distress management. We also found that patients’ anxiety was associated with higher rates of both CG depression and anxiety, underscoring the importance of interventions that address both patient and CG psychological distress. Clinical trial information: NCT01401907. [Table: see text]
Dignity therapy for advanced cancer patients.
Authors: Dose Ann Marie , Hubbard Joleen Marie 
Published: February 2017

225 Background: Recent guidelines promote simultaneous palliative care with active treatment for advanced/metastatic cancers, including interventions addressing all quality of life (QOL) domains. Dignity Therapy (DT) is an intervention demonstrating promising outcomes at end of life. It has not been offered earlier to cancer patients nor paired with a Life Plan (LP) intervention. The purpose of this phase I/II feasibility study was to determine the feasibility, acceptability and selected patient-reported outcomes (PROs) of the Dignity Therapy/Life Plan intervention and pilot study methods in advanced pancreatic cancer patients pursuing chemotherapy. Methods: DT is a brief psychotherapeutic intervention consisting a focused life review/values clarification delivered during 3 outpatient oncology clinic visits. Interviews were audiotaped, transcribed, and edited to produce a Generativity Document, which the patient can later share with family. Life Plan is a type of “bucket list”, where patients document future hopes/dreams. Feasibility was evaluated, distress measured with the Distress Thermometer (0-10 scale) and QOL measured with the Linear Analogue Self Assessment (LASA, 0-10 scale). Baseline scores of distress and QOL were compared with scores after the intervention, 4-6 weeks later (Time 2 [T2]). Results: Ten pancreatic adenocarcinoma patients enrolled, mean age 63. Two-thirds of those recruited enrolled; 90% completed all study procedures. Two-thirds were satisfied/very satisfied with DT/LP, and 78% found study participation worthwhile, DT/LP timing to be just right and would recommend DT/LP to others. QOL improved (baseline mean = 7.0; T2 = 7.25). Distress scores improved (Baseline mean = 6.13; T2 = 5.63). Conclusions: Distress and QOL modestly improved from baseline to T2. Baseline scores were collected before patients had begun any chemotherapy, therefore any improvements while undertaking aggressive chemotherapy are noteworthy. Participants felt the intervention was acceptable and better than they had expected. Conducting DT/LP in an outpatient oncology setting for newly diagnosed pancreatic cancer patients is both feasible and acceptable. Outcomes are encouraging for future larger scale trials. Clinical trial information: NCT02132325.
Enhancing the cancer survivors' experience with tailored supportive services.
Authors: Palos Guadalupe R. , Lewis-Patterson Paula A. , Chapman Patricia , Gilmore Katherine Ramsey , Rodriguez Maria Alma 
Published: February 2017

236 Background: Maintaining health and well-being is a primary goal throughout the cancer experience. The dynamic nature of a survivor’s trajectory makes it difficult to tailor education and supportive care services to their actual needs. We sought to determine information and education needs preferred by survivors who had returned to their communities after completing their treatment. Methods: We partnered with survivors' advocacy groups to conduct a needs assessment with adult survivors attending a community survivorship conference. Once eligibility was confirmed, verbal consent was obtained, and instructions were given on survey completion. A modified version of the NCI Follow-Up Care Use among Survivors survey was used. Analyses focused on clinical/sociodemographic characteristics, preferences for follow-up care, information/education needs, and sources for receiving health information. Simple descriptives were used to report the results. Results: We distributed 284 questionnaires and 169 were returned, yielding a 59.5% response rate. Respondents were mostly female (79.9%), married (58.6%), college educated (81.7%) and had ver 10 post-treatment years (47.3%). 51.3% were diagnosed with breast cancer and 81.8% reported being in good to excellent health. 57.3% had follow-up cancer care, 30.8% did not recall having a discussion with their provider about late-effects, and 57.6% reported not receiving a summary care plan. 83.7% preferred to have the same provider follow them and 95.2% reported their oncologist would be their ideal doctor. Survivors preferred more information on ways to improve memory/concentration (83.9%), energy/exercise (83.3%), and maximizing the benefits of their survivorship care plan (74.6%). Preferred information sources were health care providers (78.0%) and the internet (39.3%). Conclusions: These survivors reported a high level of unmet information needs related to self-management of physical symptoms. Patient-provider communication about late-effects and benefits of survivorship care plans continues to be inadequate. Physicians and other providers are in ideal positions to initiate conversations about supportive survivorship care early in the patient experience.
Integrated Mindfulness-Oriented Recovery Enhancement (MORE) and physical health intervention for cancer survivors with obesity: Preliminary results from a pilot randomized controlled trial.
Authors: Beck Anna Catherine , Garland Eric L. , Hansen Pamela A , Walker Darren , Reimers Celestial , Thomas Elizabeth Ann , Mijangos Jennifer , White Shelley 
Published: February 2017

237 Background: Hypothetically, interventions that reduce excessive weight and promote nutrition and physical activity may protect against cancer recurrence. Yet, obesity is often fueled by compulsive eating behaviors. Integrative therapies that combine exercise and nutrition training with techniques to enhance interoceptive awareness and cognitive control over automatic, compulsive eating may be especially efficacious. This pilot study tested the preliminary efficacy of an integrated exercise, nutrition, and Mindfulness-Oriented Recovery Enhancement (MORE) intervention in a sample of obese cancer patient. Methods: Obese (Mean BMI = 35.8) female patients (Mean age 58.41) with breast (n = 15), colon (n = 1), and endometrial cancers (n = 1) were recruited and randomly assigned to receive exercise and nutrition intervention without (POWER, n = 10) or with an additional mindfulness component (MORE POWER, n = 7). Participants met twice weekly for 10 weeks for group exercise and nutrition sessions. MORE POWER participants also participated in 10 weekly group mindfulness sessions. Pre- and post-intervention, assessments included self-report measures, weight and BMI measurement, and a cue-elicited heart rate variability (HRV) assessment. Results: The MORE POWER group evidenced significantly greater reductions in BMI (p = .015) and weight (p = .034; 6.57 lbs. vs. 1.35 lbs.) than the POWER group. The MORE POWER group also reported significantly greater increases in interoceptive awareness (p = .019) and mindful observation than the POWER group (p = .040). Increases in mindful observation predicted residualized change in BMI, Beta = -.13, SE = .05, p = .03. Lastly, MORE POWER group exhibited significantly greater post-intervention HRV than the POWER group (p = .011). Conclusions: Integrating MORE with an exercise and nutrition training program appeared to enhance weight loss outcomes in this pilot sample of obese cancer patients. Findings suggest that mindfulness training may strengthen cognitive regulation of appetitive and motivational reactions crucial to weight loss, and thereby promote health in cancer survivors.
Resiliency among nursing staff in an inpatient medical oncology unit.
Authors: Carr Alaina L , Traeger Lara , Cashavelly Barbara J. , Pirl William F. 
Published: February 2017

24 Background: Inpatient medical oncology nursing staff members often care for seriously ill patients with complex needs, and are at particular risk for burn out. This qualitative study explored the experiences of registered nurses (RN) and nurse practitioners (NP) on an inpatient medical oncology unit. We identified factors influencing resiliency in caring for oncology inpatients on a daily basis. Methods: We conducted in-depth qualitative interviews with 24 RNs and 13 NPs working on an inpatient medical oncology unit at an academic medical center. A semi-structured interview guide was used to elicit perspectives on facilitators and barriers to resilience in caring for oncology patients. Content analysis was conducted to identify themes between RNs and NPs. Results: Both RNs and NPs described being emotionally affected by daily experiences with patient suffering and death. However, they commonly identified that relationships with patients at the end of life (EOL) were sources of profound inspiration; and they felt privileged to engage with patients during this significant phase of their lives. Factors that negatively impacted resilience included a) barriers to communicating with team members and patients about EOL issues, b) successions of acutely ill patients on the unit, and c) work-life balance issues in the context of intensive shift schedules. Following emotionally difficult days, staff found motivation to return to work the next day through: a) mutual understanding and support from unit coworkers, b) sense of connection to seriously ill patients and their families, and c) general perception of oncology nursing as part of one’s identity. Conclusions: Nursing staff were intrinsically motivated to connect with seriously ill patients and to provide meaningful EOL care. Connections with coworkers and patients/families and personal identification with the role of oncology nursing helped staff to return to work after emotionally difficult experiences on the unit. Results identify potential targets for intervention to increase resiliency, including increasing workplace cohesion, communication and support within the unique inpatient milieu.
Does expected survival influence palliative radiotherapy treatment recommendations?
Authors: Ma David L , Debenham Brock J , LeGuerrier Bronwen , Paulson Kim , Ghosh Sunita , Huang Fleur , Chu Karen P , Severin Diane , Amanie John , Nijjar Tirath , Patel Samir , Rose Jim , Wiebe Ericka , Danielson Brita Lavender , Fairchild Alysa 
Published: February 2017

35 Background: Survival is often overestimated, yet physicians rely on such predictions to recommend appropriate therapy and assist with end-of-life planning. Administration of radiotherapy (RT) within the last 30 days of life has been suggested as an indicator of poor quality care, since acute side effects reduce quality of life with insufficient time for symptomatic benefit. We investigated whether life expectancy predicted at the time of consultation correlates with palliative RT recommendations. Methods: Radiation oncologists from a dedicated palliative Radiation Oncology outpatient clinic anonymously completed survival estimations after clinical assessment, and recorded factors upon which each estimate was based. Demographics, primary histology, RT details, and date of death were abstracted. Summary statistics and Kaplan-Meier estimates of actual survival (AS) were obtained. Correlations between AS and clinical predictions of survival (CPS) were calculated using Spearman’s correlation coefficient (r). Multivariate logistic regression analysis explored factors associated with RT recommendations. Results: 476 survival predictions were made for 420 unique patients (06/2010-01/2014). Median age was 67.7 years, 61.9% were male and 44.0% had lung cancer. Karnofsky Performance Status (KPS) was > 70 at 23.9% of clinic visits. At 84.5% of consultations, RT was prescribed to 538 separate volumes (29.2% receiving 8Gy, 54.8% 20Gy, 6.3% 30Gy, 9.7% other). Mean AS was 179 days (SD 187d), moderately correlating with mean CPS of 242 days (SD 261d) with r = 0.38 (p < 0.0001). Factors most frequently cited as influencing CPS were KPS and extent of disease. At the time of 30/476 visits, CPS was < 30 days; at 19 of these visits, RT was prescribed to 26 volumes (21 bone, 3 whole brain, 2 chest), 2/3 as single fractions, finishing a median of 17 days before death. Expected survival was predictive of prescribed RT dose on univariate logistic regression, but did not retain significance on multivariate analysis. Conclusions: Despite international surveys in which prognosis has been cited as the main factor affecting treatment decisions, in this cohort, other aspects appear to have more strongly influenced palliative RT recommendations.
“Ask me, do you want to know the big picture?” Gynecologic oncology patient and provider perspectives on discussing prognosis.
Authors: Lefkowits Carolyn , Kavalieratos Dio , Arida Janet , Teuteberg Winifred , Donovan Heidi , Courtney-Brooks Madeleine , Arnold Robert , Kelley Joseph L 
Published: February 2017

37 Background: Prognosis affects decision making by providers and patients and accurate understanding of prognosis may help avoid futile end-of-life care. Gynecologic oncology (GO) patient and provider perspectives on discussing prognosis have not been described. We sought to analyze patient and provider preferences regarding timing, amount and type of information included in discussions of prognosis. Methods: Semi-structured qualitative interviews regarding palliative care with 19 GO providers (7 physicians, 7 advanced practice providers, 5 nurses) and 29 patients with advanced or recurrent gynecologic cancer at an academic medical center. Communication about prognosis was one interview domain. Two coders independently and iteratively analyzed transcripts using qualitative analysis. Results: Median patient age was 61, the most common cancer was ovary (59%) and 90% had recurrent disease. Providers were 74% female with median 15 years in practice. Themes included patients wanting frank discussions about prognosis, not limited to life expectancy. Further preferences regarding timing and content were individualized. All categories of providers reported having prognosis conversations. Providers saw these conversations as part of their clinical role, though they often found them difficult. Providers commonly equated prognosis purely with life expectancy. Providers recognized variation among patients in preferences regarding these conversations, but did not discuss asking patients directly about their preferences. Conclusions: GO patients want frank discussions about what the future might hold, often including but not limited to life expectancy. Providers see these discussions as being within their scope of practice but often find them difficult. Opportunities exist for provider education regarding communication skills for assessing patient preferences and conducting patient centered prognosis discussions. Education should include GO physicians, advanced practice providers and nurses. Collaboration with specialty palliative care providers could facilitate that education and provide assistance with challenging cases.
Qualitative study of patients’ and family caregivers’ (FC) perceptions and information preferences about hospice.
Authors: El-Jawahri Areej , Shin Jennifer Adrienne , Traeger Lara , Knight Helen , Mirabeau-Beale Kristina , Fishbein Joel , VanDusen Harry , Keenan Tanya , Jackson Vicki A. , Volandes Angelo E. , Temel Jennifer S. 
Published: February 2017

50 Background: Despite the benefits of hospice for patients with advanced cancer and their FC, many patients are referred late or not at all. To assess potential patient and FC barriers to enrollment, we assessed their perceptions, knowledge, and information preferences about hospice. Methods: We conducted qualitative interviews with 16 adult patients with metastatic cancer and a prognosis ≤ 12 months and 8 of their FC. We used a semi-structured interview guide to elicit their perceptions (including perceived barriers to utilization), knowledge, and information preferences about hospice. Two raters coded interviews independently and reached acceptable inter-rater reliability (κ > 0.85). We used content analysis to identify themes. Results: We found similar themes between patients and FC interviews. Participants had mixed views about which patients need hospice with some stating it is for patients only at the end-of-life and others perceiving it as important for patients who need care their family cannot provide. Notably, most patients perceived themselves as not needing hospice in the near future. While the majority perceived the role of hospice to enhance quality of life and provide comfort, some viewed it as providing practical support, including 24-hour care. 50% of participants had positive feelings about hospice, while others were more ambivalent. All participants felt they needed more information about hospice, yet they were mixed regarding the optimal timing of this information. Many thought it would be helpful to have information about hospice through pamphlets, websites, or videos, prior to a discussion with their oncologist. Most viewed denial and hope as the main barriers to early hospice enrollment. Conclusions: Study participants had misunderstandings about which patients were appropriate for hospice and regarding the services offered. Participants expressed strong desires for more information about hospice with educational tools, although were mixed about the optimal timing for reviewing these tools. These findings suggest that patients and FC would benefit from interventions to enhance their understanding of hospice and to facilitate a discussion with their oncologists.
Meta-analysis: Risk of congestive heart failure (CHF) in selected targeted agents.
Authors: Escalante Carmelita P. , Elting Linda S. , Halm Josiah , Zalpour Ali , Bossi Paolo , Yusuf SWamique , Brito-Dellan Norman , Sahai Sunil , Bhadriraju Satish , Rouleau Tanya , Chang Yuchia 
Published: February 2017

64 Background: Congestive heart failure (CHF) is among the most serious cardiovascular side effects of targeted agents (TA) impacting the clinical outcomes (including survival) of cancer patients on this therapy. Although clinical trials have reported this toxicity, often sample sizes are small and systemic evaluations are lacking. The objective of this study is to estimate risk and severity of CHF due to selected TAs. Methods: We identified 110 English language studies of 26 TA’s approved by the Food and Drug Administration as of November 2013 via MEDLINE. Of those, 8 studies including nearly 8000 patients provided TA-related data on the incidence and severity of CHF. Using meta-analytic methods, we calculated the relative risks of CHF, adjusting for sample size using the inverse variance technique. For each TA, we also determined the number needed to harm. Results: See table. Conclusions: In 5 studies including more than 7,000 patients, trastuzumab showed significantly greater risk of CHF. For every 9 patients treated with trastuzumab, there was 1 additional case of CHF compared to control regimens. A careful patient selection before therapy and early detection of CHF by judicious monitoring of patients on this therapy may prevent serious complications and allow maintenance of cancer treatment. [Table: see text]