bluuebunny/crossref_metadata_2025_split huggingface dataset:
Retrospective chart review of end-of-life (EOL) care in patients with metastatic lung cancer harboring EGFR mutations.
Authors: Bauman Jessica Ruth , Piotrowska Zofia , Scribner Emily , Temel Brandon , Heist Rebecca Suk , Sequist Lecia V. , Temel Jennifer S. 
Published: February 2017

126 Background: Metastatic lung cancer is the leading cause of cancer-related death in the US. In the last decade, however, patients (pts) with EGFR mutations have benefitted from improved outcomes with EGFR-directed targeted therapy. We hypothesized that this improvement might impact EOL care. The objective of this chart review was to describe the care of EGFR mutant pts with attention to EOL care, health care utilization, and palliative care use. Methods: With IRB approval, we retrospectively reviewed medical records of pts at our center diagnosed with advanced EGFR-mutant lung cancer from January 2009 to June 2012. We limited the review to pts who had at least one cancer therapy at MGH, and to those who died by June 2014. Results: 44 pts were included. 30 pts (68%) were female. 32 pts (73%) received cancer-directed therapy within 30 days of death. Of these, 30 pts (68%) received oral chemotherapy and 5 (11%) received IV chemotherapy. 30 pts (68%) were hospitalized within 30 days of death. Over their entire disease course, the median number of hospitalizations was 2 (0-8), and the median number of total inpatient days was 12 (0-88). 21 pts (48%) had a palliative care outpatient visit and 34 (77%) had an inpatient palliative care consult at some point during their care. 24 pts (54%) enrolled on hospice prior to death, 15 (34%) were never on hospice, and the hospice status of 5 (11%) was unknown. Of the 39 pts with known hospice status, median length of stay was 6 days (0-206). 23 pts (52%) died at home with hospice or in an inpatient hospice, 16 (36%) died in the hospital, 2 (4%) died at home without hospice, and the location of death was unknown for 3 (7%). Conclusions: Pts with EGFR mutations had high rates of hospitalization and chemotherapy use in the last month of life, and many died in the hospital. Palliative care utilization was high, but it is unclear how this affected EOL care. Designing innovative care models to support this unique population and understand EOL decision-making should be a priority.
A prospective study: Hypodermoclysis performed by caregivers in the home setting.
Authors: Vidal Marieberta , Hui David , Williams Janet L. , Chisholm Gary B. , Allo Julio , Bruera Eduardo 
Published: February 2017

128 Background: Decreased oral intake is very common at the end of life. Dehydration can aggravate symptoms like fatigue, myoclonus, and confusion. Intravenous (iv) hydration at home can be uncomfortable and expensive. Hypodermoclysis (HDC) is a comfortable and inexpensive but rarely used way to provide hydration at the end of life in the home setting. The purpose of this study was to evaluate a program of HDC at home by the caregivers. Methods: All caregivers underwent a 45 minute training session on HDC administration and assessment of infusion site delivered by a specially trained nurse. Caregivers received daily calls and on site evaluation on day 8. Results: A total of 21 patient/caregivers dyads were admitted to this preliminary study: 10 (47%) female patients and 16 (76%) female caregivers. All patients had advanced cancer receiving hospice care at home. All caregivers who received training were able to start the infusion. Side effects were minimal with 1 (5%) care of the needle difficulty and leakage. Conclusions: This preliminary study suggests that subcutaneous hydration can be administered by caregivers at home with minimal burden. It can be easily done by just gravity or weight. It will avoid the use of expensive iv pump devices or need of special technical support. [Table: see text]
Identification of patients at risk for delirium on a medical oncology hospital ward.
Authors: Neefjes Elisabeth , Van Der Vorst Maurice , Verdegaal Bertha , Beekman Aartjan TF , Berkhof Johannes , Verheul Henk M. W. 
Published: February 2017

130 Background: Delirium is a distressing experience for patients with cancer. Incidence rates of delirium vary between 5 and 88 percent. We studied the incidence of delirium on our medical oncology ward, along with its predisposing and precipitating factors, in order to identify patients who may benefit from screening and early interventions. Methods: We evaluated patients admitted to our medical oncology ward between January 2011 and June 2012 for delirium. In this period a screening program with the Delirium Observation Screening Scale was initiated. Risk factors for delirium were extracted from the patient’s chart. We developed a prediction model to identify patients who are at risk to develop delirium and optimized this model with a cohort of patients with a delirium diagnosed between June 2012 and September 2013. Results: 1,733 admittances of 574 individual patients were recorded in the study period. Sixty episodes of delirium were identified in 52 patients. The patients had a mean age of 60 years, and most patients (70%) had advanced cancer. The most prevalent predisposing and precipitating factors were age >70, drug intoxication, infection and metabolic imbalances (abnormalities in sodium, potassium, calcium, albumin or glucose levels), which were present in 21, 25, 22, and 18 percent, respectively. The prediction model revealed that patients who were electively admitted had a very low risk to develop delirium (1%), but patients admitted for an emergency with at least one metabolic abnormality, such as hyperkalemia, were at high risk for developing a delirium (delirium risk 33%). Conclusions: Based on our analyses for risk factors of delirium, we developed a new prediction model for the risk for delirium in patients with cancer admitted to an oncology ward that may be used for targeted screening and to study preventive therapy in order to improve their quality of life.
Outcome of patients with an initial presentation of brain metastases.
Authors: Berk Lawrence , Stevens Bryan 
Published: February 2017

133 Background: Many studies have looked at the survival of patients with brain metastases but few studies have determined if the survival of patients initally presenting with brain metastases is the same as patients who subsequently develop brain metastases. Methods: Patients with no known history or a malignancy who presented to the hospital with brain metastases were retrospectively revieweed for survival. The survival data were collected from the hospital's tumor registryand the Social Security Index. The years 2010-2011 were studied as of 5/31/2013. Results: Ninety-four patients met the inclusion criteria in 2010 and eight-two patients in 2011. Sixty five percent of the patients in 2010 were male and fifty-five percent were male in 2011. The median age was approximately 60. In 2010 53% of the patients had lung cancer and 12% had breast cancer and in 2011 45% had lung cancer and 13% had breast cancer. zThus the median survival is equivalent to the median survival of the lung cancer patients, which was 71 days in 2010 and 37 days in 2011. the median survival of the breast cancer patients were 153 days in 2010 and 35 days in 2011. Sixty three percent of the patients received radiation therapy as some part of their treatment and eighteen percent received no treatment. The median survival time of patients receiving radiation therapy only as treatment was 84 days and the patients with no treatment had a survival of 34 days. Conclusions: The survival of patients presenting with brain metastases falls within the range expected from previous studies of patients with brain metastases. The survival of patients presenting with lung cancer was much poorer than patients with breast cancer. Patients for no treatment appear to be appropriately selected, with a median surival of approximately one month.
Palliative care issues encountered by radiation oncologists caring for advanced cancer patients.
Authors: Parker Gregory , LeBaron Virginia , Krishnan Monica Shalini , Shiloh Ron Y. , Racsa Margarita , Pacold Michael Edward , Spektor Alexander , Balboni Tracy A. 
Published: February 2017

14 Background: Palliative radiation therapy (PRT) is often administered to patients with advanced cancers. These patients may present to radiation oncology clinicians with other palliative care needs. To date, the types and frequencies of palliative care issues encountered in this setting have not been well characterized. Methods: This study assesses palliative care issues encountered by radiation oncology clinicians during PRT consults at 3 Boston-area, community and academic, hospital-based centers. For consecutive consults from 5/19/14 to 9/15/14, participating physicians and nurse practitioners complete a survey to identify and rank the relevance (5-point scale, 'not at all' to 'extremely') of palliative care issues. Eight domains adapted from national palliative care guidelines – physical symptoms, psychosocial issues, cultural considerations, spiritual needs, care coordination, advance care planning, goals of care, and ethical and legal issues – are evaluated. Preliminary descriptive statistics based on 51 completed surveys are reported (response rate = 94%; anticipated sample size = 198). Results: Most (82%) consults had 2 or more palliative care domains ranked as very or extremely relevant to patient care. The domains of physical symptoms (92%), care coordination (75%), and goals of care (57%) were very or extremely relevant in >50% of consults. Within these domains, the issues most often reported as relevant were interdisciplinary care coordination (92%), consideration of prognosis in treatment plan development (86%), pain management (71%), and discussion of patient values and priorities in treatment plan development (67%). Advanced care planning (24%), cultural considerations (10%), spiritual needs (10%), and ethical and legal issues (10%) were least commonly ranked as very or extremely relevant. Conclusions: Radiation oncology clinicians encounter multiple palliative care issues when consulting on patients for PRT. Clinicians identified physical symptoms, care coordination, and goals of care as the most relevant palliative care domains. These findings can help guide palliative care development within radiation oncology, including education and structures of care delivery.
End-of-life discussions with noncurable lung cancer patients: A patients' and oncologists' qualitative study.
Authors: Huillard Olivier , Vinant Pascale , Colombet Isabelle , Montheil Vincent , Guillard Marie Yvonne , Chaillot Nathalie , Moreau Nathalie , Goldwasser Francois 
Published: February 2017

151 Background: Discussions concerning patients’ (pts) preferences regarding end-of-life (EOL) care can improve the quality of care in non-curable-cancer-pts. Nevertheless having such discussions is difficult for health care providers and discrepancies exist regarding the frequency of such discussions. Methods: We conducted a single center qualitative study exploring oncologists’ attitudes and practices toward EOL discussions and the feasibility of an intervention designed to explore and collect pts’ preferences regarding EOL care. For oncologists, the intervention consisted in a semi structured interview and in a questionnaire concerning pts included. For pts, semi-structured-in-depth-interviews were conducted to assess their opinion about EOL discussions and the feasibility of exploring and collecting their preferences regarding EOL care in our practice setting. Resulting anxiety was measured. Results: Oncologists’ interviews (n=5), revealed that EOL discussions were rare, more likely to be initiated by pts and to arise lately in the evolution of the disease. Main barriers invoked were the difficulty of having such conversation, the limited time available, the risks of maleficence (mainly anxiety and loss of hope) and the uncertainty concerning expected benefits. Pts’ interviews (n=10) revealed that most of them were willing to be part of medical decisions concerning their EOL care. Few preferences regarding EOL-care were actually collected but the resulting in-depth discussions help mentioning a great variety of unusual topics as well as emotional, cultural and spiritual issues. Anxiety as a side effect was uncommon. Interviewers and oncologists often overestimated pts’ anxiety which is consistent with a projection of their own anxiety. Conclusions: Discussions concerning EOL care are uncommon in the setting studied and four main barriers were identified. Having these conversations was feasible and led to unexpected in-depth interviews concerning topics rarely addressed in our current practice. This intervention could help clarifying pts’ preferences and identifying psychosocial issues that could trigger palliative care team referral.
Care of the caregiver: Transitions at the end of life.
Authors: Page Margaretta , Molina Idonah M. , Patt Judy , Chang Susan Marina 
Published: February 2017

152 Background: Transitions of care can be particularly stressful on cancer patients and caregivers when goals of care are changing, especially at the time when active specialty care shifts to hospice. There are common caregiver issues at the end of life for the brain tumor patient as for any cancer patient however there are a subset of challenging problems unique to the disease. One of the goals of the UCSF caregiver program is to provide information on effective care at home and at the end of life to the caregiver when faced with a family member with a progressive, life threatening brain tumor. Methods: The caregiver program at UCSF sought to overcome the major caregiver challenges of the brain tumor patient at the end of life in two ways. First, caregivers of patients at the terminal phase in the illness trajectory were proactively contacted by a member of the caregiver team to offer informational and emotional support around end-of-life issues. The team also makes contact with the hospice agency in order to provide information about specifics regarding symptoms, family dynamics, or any relevant history. Second, in collaboration with the palliative care service, a palliative care and end of life handbook for brain tumor patients was planned. Results: Since June 2013, 70 caregivers of patients have been identified as “high risk” for distress because of disease progression or transition to hospice care. In addition to providing support to the caregiver at the end of life, the palliative care handbook was produced and distributed. The handbook provided general information on the role of hospice, advance care planning, and bereavement and more importantly incorporates specific sections that highlight the unique challenges regarding neurological symptoms that include cognitive and behavioral changes, language difficulties, corticosteroid use and the inability of oral intake that can significantly affect anti-seizure medication administration. Conclusions: Additional focus to ease transitions for caregivers of brain tumor patients at end of life is needed. Future projects involve creating a handbook to provide resources to hospice professionals caring for brain tumor patients that will highlight common symptoms expected, (ie. seizures) and options for management.
Association between tobacco use and symptom expression, alcoholism, and illicit drug use in patients with advanced cancer.
Authors: Kim YuJung , Dev Rony , Reddy Akhila Sunkepally , Hui David , Chisholm Gary B. , Williams Janet L. , Bruera Eduardo 
Published: February 2017

154 Background: Our aim was to determine the association between smoking status and symptom expression, opioid use, alcoholism, and illicit drug use in advanced cancer patients. Methods: We retrospectively reviewed 560 consecutive charts from the outpatient Supportive Care Center and identified 300 advanced cancer patients who completed a comprehensive smoking questionnaire. Data on the Edmonton Symptom Assessment Scale (ESAS), morphine equivalent daily dose (MEDD), CAGE (Cut Down, Annoyed, Guilty, Eye Opener) questionnaire for alcoholism screening, and history of illicit drug use were collected. Results: Among 300 advanced cancer patients, 119 (40%) were never-smokers, 148 (49%) were former smokers, and 33 (11%) were current smokers. Compared with never-smokers, current smokers were more likely to be men (58% vs. 29%, P=0.004), report a higher pain expression (median 7.0 vs. 5.0 by the ESAS, P=0.007), be CAGE positive (≥2 yes response) (42% vs. 3%, P<0.001), and have a history of illicit drug use (33% vs. 3%, P<0.001). Compared with never-smokers, former smokers were more likely to be men (60% vs. 29%, P<0.001), have head and neck cancer or lung cancer (30% vs. 13%, P=0.001), be CAGE positive (21% vs. 3%, P<0.001), and have a history of illicit drug use (16% vs. 3%, P<0.001). Current smokers reported a higher pain expression than former smokers (median 7.0 vs. 6.0 by the ESAS, P=0.01), had higher CAGE positivity (42% vs. 21%, P=0.01) and more frequent illicit drug use (33% vs. 16%, P=0.03). The MEDD and the timing of palliative care referral were not significantly different between current or former smokers compared with never-smokers. However, a higher proportion of current smokers were receiving opioids with MEDD ≥30mg at the time of palliative care consultation compared with never-smokers (70% vs. 52%, P=0.08). Conclusions: Our study suggests that current tobacco use is associated with a higher pain expression. In addition, any history of tobacco use is associated with a history of illicit drug use and alcoholism. Advanced cancer patients who smoked cigarettes may be at an increased risk for chemical coping or stronger opioid utilization and further studies are needed.
The prevalence of cough in lung cancer: Its characteristics and predictors.
Authors: Harle Amelie Sylvia Mary , Buffin Oliver , Burnham Jack , Molassiotis Alex , Blackhall Fiona Helen , Smith Jaclyn A 
Published: February 2017

162 Background: Cough commonly affects patients with LC but quoted prevalence figures vary and most were obtained before advances in anticancer treatment for LC. This study aimed to determine its prevalence and characteristics (severity, impact and potential predictors) in patients undergoing standard treatment and follow up. Methods: Consecutive LC patients attending clinics at The Christie Hospital, UK during a predefined 5 week period were asked whether they had a cough and invited to participate in its further evaluation according to an ethically approved protocol. Demographic, cancer and cancer treatment data were collected in all. Patients with a cough also completed subjective assessments using the validated cough impact Manchester cough in LC scale (MCLCS) and cough severity visual analogue scale (VAS). Standard statistical tests were used for analysis with significance (p<0.05). Results: Of 223 consecutive LC outpatients approached, the prevalence of cough was 57% (128/223); 202/223 (86%) consented to further data collection (study population) and of these 115 (57%) reported cough. The majority (60/115, 52%) felt that their cough warranted treatment and 23% reported their cough to be painful (26/115). The median VAS score (n=115) was 32mm (25th-75th IQR 20-51, range 0-100, high scores = worse cough severity). The median MCLCS score (n=113) was 22 (25th-75th IQR 16-27, range 1-50, high scores = worse cough impact). There was no significant difference between coughers and non-coughers with respect to age, sex, co-morbidities, smoking, performance status, treatment intent, treatment type, reasons for not receiving treatment, stage and histology. The proportion of non-coughers was lower among patients receiving anticancer therapy (45/115 39% vs 47/87 54%, p=0.04) in univariate analysis. Conclusions: Cough is present in the majority of LC patients, even in those undergoing treatment. Many patients feel that it warrants treatment. Whilst many consider factors such smoking, stage, histology and cancer treatment type to be important determinants of the presence of cough, our data does not reflect this. Improving LC related cough requires more than better cancer therapies.
Developing pathways for cancer rehabilitation in tertiary oncology centers: Initial observations at the McGill University Health Centre.
Authors: Cesare Sabrina , Uscatescu Irina , di Tomasso Jonathan , Ciutto Lorella , Yu-Chueh Kevin , Olders Henry , Aubin Nathalie , Kelly Mary Lou , Jelowicki Marta , Laroui Rabiaa , O'Grady Rosemary , Borod Manuel , Kilgour Robert , Vigano Antonio Angelo Luciano 
Published: February 2017

17 Background: No definitive rehabilitation pathways exist for cancer patients. To address this gap, the Cancer Rehabilitation interdisciplinary team at the McGill University Health Centre has developed three program paths (e.g., Restorative, Supportive, and Cachexia) to meet the various specialized and personalized needs of cancer patients. Methods: A consecutive cohort of patients referred to the Cancer Rehabilitation Clinic between January 1st and June 30th, 2014 was considered. We examined the following baseline characteristics: handgrip strength (HGS), the abridged Patient Generated-Subjective Global Assessment (aPG-SGA) and Edmonton Symptom Assessment System (ESAS) self-reported questionnaires. Results: Of the 54 patients evaluated (57.4% male), 20 (mean age: 47.4 yrs), 8 (59.9 yrs) and 26 (64.6 yrs) were assigned to the restorative, supportive and cachexia streams, respectively. The most common cancer diagnoses were gastrointestinal (15%), gynecological (13%), breast (12%) and lung (12%). Table 1 contains baseline aPG-SGA, ESAS and HGS scores. Conclusions: Our preliminary data confirm clinically significant differences in muscle strength across the 3 streams for both males and females, as well as significant differences in nutritional, appetite and well-being scores between the patients in the restorative and cachexia pathways. Our data confirm the need of personalized and targeted interventions to achieve or maintain optimal performance and quality of life in cancer survivors with different disease and treatment characteristics. [Table: see text]