bluuebunny/crossref_metadata_2025_split huggingface dataset:
Do differences in patient-provider relationships explain racial differences in side effect burden among women with breast cancer in the pathways study?
Authors: Check Devon , Chawla Neetu , Ergas Isaac J. , Roh Janise M. , Kolevska Tatjana , Kushi Lawrence , Kwan Marilyn L. 
Published: November 2017

48 Background: Prior research suggests that black patients with cancer report a greater burden of symptoms compared to white patients. Differences in patient-provider relationships may be an underlying and modifiable factor in these observed disparities. We examined differences in side effect burden by race/ethnicity and tested the hypothesis that patient-provider communication and trust may partly explain differences in symptom burden among women with breast cancer (BC). Methods: We conducted a cross-sectional analysis of data collected from 4,505 women diagnosed with BC from 2005-2013 at Kaiser Permanente Northern California. Women were asked two months post-diagnosis how much they were bothered by treatment side effects (FACT-B). Using modified Poisson regression, we assessed the association of race/ethnicity with side effect bother, adjusting for clinical characteristics, socioeconomic status (SES), and patient-provider communication and patients’ trust in providers in a step-wise fashion. Provider communication and trust were measured using the Interpersonal Processes of Care survey and a one-item assessment of patients’ trust in providers, respectively. Results: Before adjustment, Black, Hispanic, and Asian patients were at least 75% more likely than white patients to report high (vs. low) side effect bother (p < 0.0001). Bivariate associations of communication and trust with side effect bother and race/ethnicity were statistically significant. For example, patients with high (vs. low) scores for shared decision-making were more likely to be white than black (46% vs. 39%) and less likely to experience high vs. low side effect bother (10% vs. 14%, p < 0.0001 for both comparisons). However, after adjusting for clinical and SES characteristics in a multivariable analysis, the addition of patient-provider communication and trust to the model did not substantially alter disparity estimates. Conclusions: In our sample, patient-provider communication did not modify racial disparities in side effect bother. Further research is needed to explore additional modifiable factors underlying potential disparities in side effect management.
Hereditary cancer prevalence and communication about family history risks in palliative care.
Authors: Razzak A. Rab , Bailey Lauren , Yu Brandon , Abusamaan Mohammed , Kang In Guk , Ma Brittany , Emidio Bunmi , Owodunni Oluwafemi , Smith Thomas J. , Bodurtha Joann 
Published: November 2017

56 Background: Hereditary cancer (CA) assessment & communication about family history (FH) risks in palliative care are underexplored & could be critical for surviving relatives. FH may not be adequately reviewed & appropriate information conveyed in the palliative care (PC) setting, even though family health is a legacy concern of patients. Cancer patients seeking PC never wish for their relatives to have CA & may be an important resource for communication about their relative’s CA risk & appropriate referrals. Methods: This prospective observational study among cancer patients receiving PC consultations was conducted at a 977-bed academic urban hospital between June 2016 & March 2017. Data were collected through structured interviews and chart review during hospitalizations. Results: 75 adult cancer patients were enrolled. Patients’ average age at diagnosis was 55.3 ± 15.7 years. 41(55%) self-identified as male; 34(45%) as female; 20(27%) as black, 49 (65%) white, and 6(8%) other. 24 patients (32%) were considered to have pedigrees that merited referral as high-risk. 32 patients (43%) thought that their CA had a likely genetic or inherited component. 48(64%) thought the palliative care setting was an appropriate place to discuss the implications. The mean comfort level in addressing these questions was 8.7 on a 10 point scale with 10 indicating extremely comfortable. Conclusions: Review of FH may be an intervention that PC providers & families can discuss & incorporate in legacy activities. This could enhance CA prevention, especially among high-risk families. There is room for enhancement in how FH & patient and family concern are integrated in the palliative & cancer care continuum.
Education program for cancer patients and families.
Authors: Messinger Marina , Yadav Udit , Thekkekara Romy Jose , McDunn Susan H. 
Published: November 2017

57 Background: Studies of patient education and communication have been shown to affect patient health outcomes, including emotional and physical health. Effective patient education is challenged by limitations in patient literacy. As much as 20% of the American population was found to have a low literacy level at or below a 5th grade reading level. Our program was based in a public hospital treating underserved patients from lower socioeconomic backgrounds who often have low baseline health literacy and varying educational backgrounds. Methods: A cancer patient education program was organized for recently diagnosed cancer patients and their families. A lecture and interactive learning session was implemented to teach the basics of what cancer is, what chemotherapy is, social services available to patients, and counseling services available. A pre- and post-survey was administered to assess patients’ confidence in their understanding of cancer, chemotherapy, navigation of social and counseling services. Patients self rated their level of understanding as “poor”, “a little”, “average”, “good”, or “very good”. Results: Comparison of pre- and post-survey results showed self-assessed improvement of understanding of cancer, chemotherapy, social services, and counseling services by more than one level of understanding (1.29, 1.37, 1.18, 1.14 level of understanding improvement respectively). Conclusions: A patient education program for cancer patients teaching the basics of cancer and chemotherapy as well as giving patients and families resources for social services and counseling services is a very necessary resource. Better patient understanding of health issues may improve compliance with treatments, help alleviate anxiety, and enable patients and their families to participate actively in their care. This need is especially felt in a hospital treating an underserved population. Survey results show an improvement in patient self-assessed understanding of cancer, chemotherapy, and social services.
Goals of care documentation in advanced cancer.
Authors: Harle Ingrid , Karim Safiya , Booth Christopher M. 
Published: November 2017

58 Background: Documenting goals of care (GOC) is integral to patient centered care, decision making and quality performance. Studies show patients value conversations about GOC after receiving a terminal diagnosis. Positive effects have been demonstrated for survival, quality of life, disease management and healthcare savings. The ASCO QOPI recommends documentation within 3 visits from diagnosis of metastatic cancer. For hospital inpatients, GOC are more often integrated into care planning, as admissions frequently reflect changes in illness trajectory, yet documentation remains poor. This Quality Improvement (QI) initiative aims to increase GOC documentation for ambulatory patients and referral rates to Palliative Medicine. Methods: A retrospective cohort receiving palliative chemotherapy for metastatic lung, pancreas, colorectal and breast cancers during 2010-2015 were identified from pharmacy records at a Canadian Regional Cancer Centre. Inclusion criteria required a minimum of 4 clinic visits post treatment. Clinical notes of Oncologists and Palliative Medicine Physicians were reviewed for GOC documentation and referrals to Palliative Medicine. Baseline data determined improvement target rates. A clinical practice QI initiative applied passive and active phases, beginning May 2016. Passive phase included the development of a guideline, documentation template and referral process. The active phase is the implementation process (ongoing). Results: A cohort included 456 patients with metastatic cancer, 63% lung cancer. Oncologists documented GOC in 6% (26/456) and referred 47% to Palliative Medicine. GOC rate was 48% post-referral. Improvement target rates were set at 40% and for referrals 70% by March 2017. Analysis during the passive phase showed Oncologists’ GOC documentations increased to 15%. Analysis of the active phase is ongoing and preliminary results will be presented. Conclusions: Low rates of GOC documentation and referrals to Palliative Medicine persist. The passive phase of engaging physicians in the QI development positively influenced GOC documentation. This QI initiative will inform the sustainability of GOC documentation, Palliative Medicine referrals and standardization of institutional guidelines.
Do hospitalized cancer patients requiring palliative care consultation discharged to subacute rehabilitation ever get anticancer therapy again?
Authors: Khan Muhammad Azeem , Pettit Clint S. , Groninger Hunter 
Published: November 2017

62 Background: Patients with advanced cancer inevitably experience a functional decline that is often associated with notable symptom burden and/or indications for clarification of goals. Palliative care (PC) services frequently engage such patients during hospital stays. For many of these patients, discharge plans to sub-acute rehabilitation facilities (SAR) in order to ‘gain strength’ for future cancer treatment is a common practice. We wished to examine if inpatients with advanced cancer receiving PC consultation who are discharged to SAR are ever able to follow up with their oncology team and receive anti-cancer therapy. Methods: A search was conducted in our institution’s electronic medical system for hospitalized patients with cancer who received inpatient PC consultation and were subsequently discharged to SAR. Patients were excluded if they did not follow with an oncologist at MWHC as an out patient prior to the admission being reviewed or if they had never received anti cancer therapy before. Results: From 2015-2017, 16 patients meeting our criteria were identified. For 14 (82.4%) patients Palliative Care was consulted to either discuss goals of care and/or assist with pain management.13 (76%) patients were discharged to SAR to ‘improve strength’. However only 7 (44%) patients saw their oncologist after discharge from SAR. Of those 7 only 3 (19%) received further anti cancer therapy. 4 of the 7 (57%) patients that saw their oncologist after SAR had an ECOG of 1 on admission, the other 3 had an ECOG of 2. No patient with an ECOG of 2 or greater ever received cancer treatment again. Exactly half of the 16 patients were eventually readmitted to our hospital. Conclusions: SAR may not be an appropriate discharge disposition for patients with cancer who have a decline in functional status. Less than half the patients with cancer discharged to SAR from our institute with the intention to gain strength for future chemotherapy saw their oncologist again and the overwhelming majority (particularly those with an ECOG performance score of 2 and greater) never received anti cancer therapy again. This data can be considered to make informed decisions when discussing goals of care.
Prognostic factors, symptoms, and consequences of electrolyte imbalances in patients who suffered from cancer.
Authors: Bryniarski Pawel 
Published: November 2017

74 Background: Dyselectrolytemia is a common problem in patients with terminal cancer. It worsens the quality of life and increases the amount of complications. The aim of our study was to determine factors connected with dyselectrolytemia in patients with terminal cancer. Methods: 310 terminal cancer patients admitted to Palliative Care Unit were retrospectively analyzed. Detailed physical examination, medical history and laboratory parameters were taken upon admission. Univariate and multivariate logistic regression analysis were used to determine possible predictors, symptoms and consequences of dyselectrolytemia. Results: On admission 67,74% of patients had dyselectrolytemia. They were more frequently admitted to hospital from Emergency Department (OR=Odds Ratio=2,879, p=probability value=0,00004), had higher PS scale note (OR=1,627, p=0,0001), were more often cachectic (OR=1,915, p=0,0083), had more often constipation (OR=1,728,p=0,0275), were more often dehydrated (OR=2,609 ,p=0,0007), had lower albumin level (OR=0,909, p=0,00001). They had 275% higher risk of death (OR=2,758, p=0,0001). Multivariate logistic regression analysis after adjustment for possible confounders reviled that admission to hospital from Emergency Department (OR=2,652, p=0,01), higher PS scale note (OR=1,445, p=0,001), opioids administration (OR=2,747, p=0,003), dehydration (OR=1,966 , p=0,038) and higher risk of death (OR=2,432, p=0,002) remained independently associated with dyselectrolytemia. Conclusions: Higher PS scale note, occurrence of dehydration, admission to hospital from Emergency Department and opioids administration are factors associated with dyselectrolytemia. Patients with electrolytes imbalances had 275% higher risk of death. Project "Extension of life and improvement of its quality and reduction of cancer patients' mortality due to proper control of water and electrolyte management and elimination of risk factors for dehydration and dyselectrolytemia." Co-financed by the European Social Fund under the project of the Ministry of Science and Higher Education of Poland entitled "Best of the best! 2.0 ".
Pharmacokinetics/pharmacodynamics (PK/PD), safety, and tolerability of fosaprepitant for the prevention of chemotherapy-induced nausea and vomiting (CINV) in pediatric subjects.
Authors: Mora Jaume , Valero Miguel , DiCristina Cara , Jin Mandy , Chain Anne , Bickham Kara 
Published: November 2017

93 Background: Fosaprepitant is approved to prevent CINV in adults. The aim of this study was to determine appropriate fosaprepitant dosing in children. Methods: This was a phase 2b, multicenter, randomized, dose-ranging study to evaluate PK/PD, safety, and tolerability of a single dose of fosaprepitant administered concomitantly with ondansetron, with or without dexamethasone. Eligible subjects were newborn to 17 years of age who were scheduled to receive emetogenic chemotherapy for a documented malignancy. PK/PD data were collected in cycle 1 only. The study was designed to compare 3 doses of fosaprepitant versus placebo in 2 to 17 year olds, with an open-label amendment evaluating a fourth dose in <12 year olds. Pediatric exposures were compared with historical adult PK data. Results: 234 subjects were enrolled and received study medication (Table). All but one completed cycle 1. One subject (5 mg/kg regimen) discontinued because of anaphylactic reaction. In 167 subjects with evaluable PK data, aprepitant exposures were dose proportional. Adolescents (12-17 years) receiving fosaprepitant 150 mg had exposures similar to adults at the same dose. Owing to a higher clearance in children <12 years old, a higher weight-normalized dose (5 mg/kg) was necessary to achieve comparable exposures. The AE profile was typical of subjects with cancer receiving emetogenic chemotherapy. The most common drug-related AE was hiccups. Conclusions: In pediatric subjects receiving fosaprepitant to prevent CINV, aprepitant exposures were dose proportional. Subjects <12 years old required higher doses to achieve exposures comparable with adults. Fosaprepitant was well tolerated in this population. Clinical trial information: NCT01697579. [Table: see text]
Using electronic patient reported outcomes to identify gaps in quality of care in radiation oncology.
Authors: Marquez Celine Denise , Braunstein Steve E. , Morin Olivier , Fogh Shannon E. 
Published: November 2017

94 Background: Improving quality of care involves identifying patient health needs and designing systems to meet those needs reliably. Within Radiation Oncology, patient health needs encompass measurable, physical quantities such as a reduction in tumor size, as well as subjective needs, as in freedom from pain. Patient reported outcomes (PRO) have the potential to identify subjective health needs and to guide treatment towards symptoms patients find most bothersome, thereby improving quality of care. Here we report the unmet health needs revealed by systematic electronic PRO data collection in a Radiation Oncology department. Methods: 50 consecutively treated patients for a variety of malignant and nonmalignant, primary and metastatic disease were surveyed within the CNS subdivision of a single Radiation Oncology department using electronic EORTC QLQ C30 or PRO-CTCAE CNS forms displayed on a touch screen tablet. Patients were then followed with PRO surveys at two additional time points, 1-2 weeks post radiotherapy treatment and again at one month. Results: Of 27 planned PRO CTCAE surveys of 9 patients, 22 (81%) were completed and available for evaluation. 6/9 (67%) of patients taking the PRO CTCAE reported “severe” or “very severe” side effects. The most commonly reported “severe” or “very severe” symptoms were fatigue (6/9, 67%), insomnia (3/9, 33%), anxiety (2/9, 22%), and sad/unhappy feelings (2/9, 22%). Of 123 planned EORTC QLQ C30 surveys of 41 patients, 109 (89%) were completed and accessible for evaluation. 38/41 (93%) of patients taking EORTC QLQ C30 reported side effects impacting their lives “quite a bit” or “very much”. The most common symptoms impacting patients “quite a bit” and/or “very much” were fatigue (25/41, 61%), pain (17/41, 41%), insomnia (15/41, 37%), and worry (14/41, 34%). Conclusions: Gaps that may exist between the quality of care we wish to provide and the care patients experience may be recognized and addressed by incorporating PROs into our standard clinical practice. Integrating electronic PROs into our clinical systems will help us to more reliably identify unmet patient health needs, personalize care, and respond to side effects and symptoms that are of the greatest concern to patients.
Impact of a clinical pathway tool on appropriate palliative radiation therapy for bone metastases.
Authors: Rotenstein Lisa , Kerman Alexander O. , Martin Neil E. , Balboni Tracy A. , Krishnan Monica Shalini , Killoran Joseph , Taylor Allison 
Published: November 2017

97 Background: Clinical pathways increase compliance with treatment guidelines, improve outcomes, and reduce costs. Guidelines recommend single fraction radiation therapy (SFRT) for palliation of uncomplicated bone metastases, but implementation is variable. We examined the effects of a clinical pathway tool on appropriate SFRT rates in an academic radiation oncology practice. Methods: Clinical pathways increase compliance with treatment guidelines, improve outcomes, and reduce costs. Guidelines recommend single fraction radiation therapy (SFRT) for palliation of uncomplicated bone metastases, but implementation is variable. We examined the effects of a clinical pathway tool on appropriate SFRT rates in an academic radiation oncology practice. Results: The final pathway was used in 38% of 723 bone metastases radiation prescription made since March 2016, with appropriate SFRT rates rising from 18% prior to implementation to 48% post-launch in cases where the pathway was used (p < 0.01). There was no increase in the appropriate SFRT rate for cases treated after March 2016 but not entered into the pathway tool as compared to cases prior to pathway tool implementation. Major reasons for rejecting recommendations included disagreement with life expectancy prognostication and patient convenience. The pathway increased physicians’ confidence regarding compliance with treatment guidelines and made it easier to find well-supported treatment recommendations. Workflow disruptions and the inability to handle nuanced situations emerged as limitations. Conclusions: Our experience demonstrates the utility of clinical pathway decision support for bone metastases in complex academic settings. Pathway use significantly increased appropriate care, more than doubling appropriate treatment rates relative to a synchronous group. Next steps include increasing the pathway’s ease of use, refining its prognostic abilities, and measuring related value effects.
Nurses’ roles and responsibilities in the provision of early palliative care: A grounded theory study.
Authors: Mohammed Shan Darrel , Savage Pamela , Zimmermann Camilla 
Published: November 2017

98 Background: The benefits of providing early palliative care (EPC) are well researched. Few studies have explored the knowledge and skill used by nurses to help patients and families transition to and receive palliative care. In this study, we examine the roles and responsibilities of nurses in the provision of EPC and explore some of the barriers and facilitators they encounter as part of this complicated work. Methods: We drew on constructivist grounded theory to guide our methods and analysis. Nurses were recruited from several ambulatory care clinics in a comprehensive cancer center in Ontario, Canada. Nurses who participated in the study completed semi-structured interviews seeking to examine the roles, responsibilities, knowledge, and skills they utilized to provide EPC. Results: Ten nurse practitioners, six staff nurses, and four advanced practice nurses completed interviews for a total of 20 participants. Participants practiced in a variety of settings such as head and neck, breast, pancreatic, and hematology. The core category Brokering Palliative Care includes three subcategories: (1) Moving backwards and forward – stepping back to assess patients’ willingness to hear about EPC and then proceeding by selling the benefits of palliative to improving everyday function; (2) Addressing misconceptions and stigma – dealing with patients’ assumptions about palliative care as diminishing hope and accelerating the end of life; and (3) Advocating with the interprofessional team – bringing patient concerns forward to the team, managing interprofessional dynamics, and seeding the process of referral to EPC. Conclusions: Oncology nurses play a central role by brokering EPC for patients with serious cancers and their families. They draw on their proximity to patients, relational and communication capabilities, care coordination skills, and advocacy abilities. Brokering palliative care is conditional on nurses’ comfort level, experience, workload, and relationships with other healthcare professionals, especially oncologists. Moreover, the brokering work of nurses must be enacted within the boundaries of the nursing role and their relative position within the healthcare system.