bluuebunny/crossref_metadata_2025_split huggingface dataset:
Predictors of early referral of advanced cancer patients to an outpatient palliative care specialty clinic in a tertiary cancer hospital.
Authors: Dalal Shalini , Dev Rony , Tanco Kimberson , Williams Janet L. , Bruera Eduardo 
Published: February 2017

136 Background: Integration of palliative care (PC) with oncologic care has been advocated. In recent years our group has observed increased referral of cancer patient in earlier stages of illness. Our study objective was to compare clinical characteristics of advanced cancer (aCA) patients referred by their oncologists within 2 months of aCA diagnosis (early referral, ER) versus those referred more than 2 months later (late referral, LR). Methods: We collected data on baseline characteristics, symptoms, and the timing of PC referral on consecutive cancer patients seen in first consultation at the outpatient PC specialty clinic in fiscal year 2013. Results: Of the 1225 cancer patients referred for PC consultation, 968 (79%) patients had aCA, of which 38% (n = 372) were seen as ER, and 62% (n = 596) as LR. As compared to the LR group, patients in the ER group had significantly higher severity of pain, SOB, anxiety and drowsiness. In the ER group, a significantly higher proportion of patients had aCA status at initial presentation to their oncologist as compared to the LR group (83% versus 60%; p < 0.0001). Of all the referring primary services, Thoracic Medicine was the only service where a majority of aCA patients were in the ER group (161 versus 122 patients; p < 0.05). In regression analysis, the odds of patients being referred early was higher if they belonged to the Thoracic Medicine service, had aCA at initial presentation to their oncologist, and had higher severity of fatigue and drowsiness. Overall, the median survival of aCA patients, calculated from date of PC consultation, was 5.9 months, and did not differ between ER and LR groups (6.1 and 5.8 months; log-rank 0.832). Conclusions: Our study demonstrates that oncologist’s decision to refer patients early to PC clinic depends on the type of primary service, having advanced stage disease at initial presentation, presence of symptoms of fatigue and drowsiness, and prognostication of decreased survival. The median survival time of 6 months from PC consultation is encouraging and suggests earlier PC referral of cancer patients as compared to earlier reports.
Impact of integrated palliative care model on end-of-life (EOL) quality metrics for patients with kidney cancer (RCC) and melanoma (M).
Authors: Lynch Jessica A. , DeSanto-Madeya Susan , Zerillo Jessica A. , Gregas Matt , McDermott David F. , Mukamal Kenneth J. , Buss Mary K. 
Published: February 2017

137 Background: Early palliative care (PC) improves quality of life (QOL) and enhances end-of-life (EOL) care, but the optimal timing and most effective model for integrating PC into oncologic care is uncertain. To understand the impact of an integrated model with PC providers embedded with oncologists vs. usual care (UC) with referral at the discretion of the same oncologists, we examined the timing and delivery of PC and Quality Oncology Practice Initiative (QPOI) EOL metrics among patients with RCC and M in a single clinic. We hypothesized that integrated PC would result in more referrals, earlier contact with PC and better QOPI EOL metrics compared with UC. Methods: In a retrospective cohort study of patients with RCC and M in the Beth Israel Deaconess Biologics Clinic who expired between 10/1/12 and 12/31/14, we compared patients seen 2 days/week, when referral to PC was discretionary, with a third day when PC providers shared the clinic for real-time consultations. Patients were identified as meeting PC eligibility if they had recurrent, metastatic disease and were on active treatment or had a symptom severity of 7+ on Edmonton Symptom Assessment Scale (ESAS). Two oncologists saw all patients, regardless of day. Results: Seventy-six patients expired, 19 in the Integrated PC model and 57 with UC. Patients were similar with respect to diagnosis and demographics except for smoking. The integrated model substantially improved timing and location of PC. In the integrated PC model, 85% were seen by PC compared with 45% in UC (P = 0.002). All patients in the integrated model began PC as an outpatient compared with 36% in UC (P < 0.001). The mean number of days from first PC contact to death was 28 (SD = 54) for UC and 118 (SD = 120) with integrated PC (P < 0.001). The location of death did not differ significantly between models, occurring outside the hospital with hospice among 71% of patients in the integrated model and 53% in UC (P = 0.25). Results were similar in relative risk models adjusted for smoking. Conclusions: A practice model that integrated PC with oncologic care was associated with more PC referrals, earlier contact, and a nonsignificant trend toward fewer deaths in hospital and ICU.
Analysis of patient care in a “Palliative Medicine Day Care Unit” in a hospital in Costa Rica during its first year.
Authors: Cartin Andrea , Benavides Rosaura , Zeledon Manuel 
Published: February 2017

140 Background: A “Palliative Medicine Day Care Unit” (PMDCU) program began in January of 2014 as part of the services provided by the Department of Palliative Medicine in a national hospital in Costa Rica; the program allows patients with hemato-oncological diseases to continue as outpatients while receiving inpatient treatment for their refractory symptoms. This study analyses patient consult rates, results and the dynamics of the unit during its first year in service. Methods: The statistical information of patients attended in the PMDCU, were collected during the period between January and December of 2014. The data included: the population characteristics, the nature of the care provided and the interaction with other departments. Results: A total of 1311 patients were examined in the PMDCU, for a total of 1609 consultations; on average each patient had 3.6 consultations. The average time patients spent with physicians during consultation or receiving treatment were 115 minutes. The most common patient diagnosis was gastrointestinal, gynecological, and prostate cancers. After the initial consult, 63% of patients continued treatment in the outpatient clinic of the same hospital, 34% were scheduled for follow-up consultations in the PMDCU, 2.4% of patients were referred to the Emergency Department and less than 2% of patients were either admitted to the hospital or were referred to other palliative care units. Treatment in the PMDCU included, analgesia treatment administration, paracentesis, thoracocentesis, parenteral nutrition, blood transfusions and patient and family education. Conclusions: The PMDCU has had acceptance among patients with a high number of consultations and adequate follow up of patients. The most common types of cancer diagnosis were gastrointestinal, gynecological and prostate cancers. The majority of patients examined, continued treatment in either the outpatient clinic or follow up in the PMDCU; few were referred to the emergency department. The PMDCU provides treatment that would normally be administered either in an inpatient setting or in the emergency department, but avoiding the extra cost and inconvenience to the patients and their family.
Measuring implementation of early, concurrent palliative care in community settings.
Authors: Bakitas Marie , Dionne-Odom J Nicholas , Pisu Maria , Babu Dilip Sankar , Smith Tasha , Akyar Imatullah , Zubkoff Lisa 
Published: February 2017

145 Background: ASCO recommends “…combined standard oncology and palliative care…early in the course of illness for any patient with metastatic cancer and/or high symptom burden”. Few settings have implemented this recommendation and rural community cancer centers (CCC) are particularly disadvantaged due to scarce palliative care (PC) resources. The evidenced-based ENABLE (Educate, Nurture, Advise, Before Life Ends) early concurrent PC intervention has demonstrated efficacy and benefit for rural patients and caregivers and we are implementing ENABLE using a virtual learning collaborative funded by the American Cancer Society. Since no PC-specific implementation measures exist, one of our primary efforts has been instrument development. Methods: This Implementation Study includes 4 racially-diverse CCCs: Gibbs Cancer Center, Spartanburg, SC; Mitchell Cancer Institute, Mobile, AL; Birmingham VAMC; and Gyn Oncology/University of Alabama at Birmingham. The project aims are to: 1. Build an interactive research community to assess sites’ institutional structure and PC resources; and 2. Evaluate pre- and post-ENABLE implementation using RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework. An expert panel assisted with implementation measure development specific to ENABLE’s essential elements. Instruments include: the General Organizational Index, the RE-AIM Assessment Tool, Oncology Providers Perceptions of Early Concurrent PC, and Implementation Costs. Results: All measures were found to have face and content validity. Feasibility and inter-rater reliability were determined during pilot-testing. Data, (housed in a REDCap database), have been collected using face-to-face interviews and web-based platforms over 2 cycles of pre- and post-implementation site visits. Measurement challenges include: 1. Inconsistent IRB interpretation of implementation science practices; 2. Limited implementation resources (space, staff, and time); and 3. Difficulties with centralized data collection. Conclusions: Valid measures are critical to determine implementation success. We will present implementation measures (Toolkit) and examples of outcome data.
Beyond the pilot: Navigating through 8 years of palliative radiotherapy integrated symptom management (PRISM).
Authors: Huang Fleur , LeGuerrier Bronwen , Severin Diane , Eberle Shannon , Chu Karen P , Gagnon Lori , Fairchild Alysa 
Published: February 2017

156 Background: Patients with incurable cancer often have problematic symptoms and functional impairment despite active cancer care. Opportunities to assess and address these unmet needs exist at every care point. Methods: In 2007, we piloted a holistic model of care in an outpatient Palliative Radiation Oncology clinic. Twin goals (timely access to radiotherapy (RT) and multidisciplinary (MDT) symptom assessment/management) were met: a one-stop-shop to see a radiation oncologist (RO), nurse (RN), radiation therapist (MRT(T)) and pharmacist, with Social Work, Nutrition and Rehabilitation as needed. The model has since evolved, adapting to shifting system-level barriers, with continued attention to patient-reported outcomes. We discuss our team’s 8-year effort to integrate symptom management and palliative RT in a tertiary cancer center. Results: Despite challenges (patient-, provider-, facility-, service- or logistics-related), our target RT population grew from initially only those with bone metastases (served by 1 RO once weekly), to include brain or chest disease (seeing any local RO, any day). Priorities were complex, even at odds, to cater to broadly defined stakeholders: access to RT, systematic basic supportive care (BSC), operational efficiency, care transitions. From strong interdisciplinary focus and task-shifting emerged a critical patient navigation piece. Informal, then formal quality improvement work recast key functions by person/time/place, recently streamlining (e.g. intake/triage/referral pathways) and upgrading (e.g. shared RN/MRT(T) navigator role). Interfaces are layered, broad now between BSC (e.g. horizontal pre-/post-visit telephone symptom screening and goal-setting) and RT processes (e.g. more consistently vertical, less disruptive to technical workflows), enabling scale-up and alignment by design with quality dimensions. Operational and patient outcome metrics remain under periodic review. Conclusions: Integrating MDT BSC with outpatient palliative RT is feasible and scalable, when incrementally tailored to context. Further work, to formally assess patient satisfaction and downstream care needs, will inform PRISM as our local standard.
Embedded integration of palliative care in an academic outpatient cancer center.
Authors: Sinclair Christian T 
Published: February 2017

158 Background: Palliative care is no longer reserved for ICUs and inpatient settings, since it can be delivered at any age and any stage regardless of goals of care. Oncologists are beginning to embrace more upstream palliative care but translating that to the long term setting has unique difficulties. Outpatient palliative care is a vital component to quality oncology care, but few examples of successful integration have been demonstrated. Methods: Data was collected from the palliative care clinic at the University of Kansas Medical Center Westwood Cancer Center. Descriptive analysis of the initial and current programs as well as successful outreach and education projects will be discussed. Quantitative analysis of number of initial and follow-up outpatient visits, cancer type, referring service and referring physician are all included. Hospice utilization was also recorded as well as length of time from initial consult to either death, discharge or calendar date June 30, 2015. Results: Since the pilot clinical program of outpatient palliative care in 2012 with two half day clinic sessions focused on BMT patients, the program has expanded to 5 half-day sessions and includes medical oncology, surgical oncology and gynecologic oncology. Referrals to palliative care have grown consistently covering multiple cancer diagnosis and including the entire oncology staff instead of a few champions. Increase in outpatient utilization has also spurred more early and appropriate inpatient palliative care utilization. Staff have moved from crisis-only use of outpatient palliative care to a co-management model. Conclusions: Outpatient palliative care can be successfully integrated into an NCI academic medical center oncology practice. (Note: More detailed data will be presented at the conference on all of the trends mentioned above.)
Predictors of referral to outpatient specialty palliative care (SPC) in gynecologic cancer (GC) patients.
Authors: Ruskin Rachel , Rowland Michelle Renee , Moore Katherine N , Slaughter Katrina , Walter Adam , Landrum Lisa Michelle , Walker Joan L. , Matzo Marianne 
Published: February 2017

159 Background: Prior studies in GC patients have described predictors of inpatient palliative care (PC) consultation, but predictors of outpatient SPC consultation have not been elucidated. We sought to identify factors predictive of referral and associated care outcomes. Methods: We performed a cross-sectional study of GC patients seen in the gynecologic oncology clinic at a comprehensive cancer center over a three month period. As a part of routine care, patients completed a symptom questionnaire. Patients previously seen at the outpatient PC clinic were compared to those who had not with respect to demographics, disease characteristics, symptom scores, and provider factors using univariate statistics. A multivariate model was created to identify independent predictors of referral. Results: 913 patients completed the symptom survey. 76 patients (8%) had been seen in the outpatient PC clinic. Disease factors associated with referral included site (p < 0.01), stage (p < 0.01), evidence of disease (p < 0.01), active treatment (p < 0.01), and time point in the disease trajectory (p < 0.01). Women with moderate to severe pain (p < 0.01), sadness (p = 0.03), distress (p < 0.01), fatigue (p < 0.01), neuropathy (p = 0.03), and sexual dysfunction (p < 0.01) were more likely to have seen PC. Marital status, number of symptoms, and patient provider were also predictive of referral (all p < 0.01). In a multivariate model, site, stage, number of symptoms, moderate to severe sexual dysfunction, and provider were independently associated with referral. Compared to women who had not been referred, patients seen in the PC clinic were more likely to have a health care proxy documented in the electronic medical record (p < 0.01). Among patients with related symptoms, patients referred to PC more often had an opioid prescribed for pain (p < 0.01) and medications prescribed for depression (p < 0.01), anxiety (p = 0.04), insomnia (p < 0.01), and fatigue (p < 0.01). Conclusions: Women with depression, anxiety, insomnia, and fatigue were more likely to receive pharmacologic treatment for these symptoms from a SPC provider. Future research should identify referral triggers for those patients most likely to benefit from outpatient SPC consultation.
Integration of palliative care services into standard oncology practice at diagnosis of metastatic lung cancer at VA New York Harbor Healthcare System.
Authors: Rivera Mercado Felix Manuel , Luhrs Carol , Beal Alice , Langdon Maura , Secrest Joan , Talbot Susan M. 
Published: February 2017

165 Background: The 2012 ASCO provisional clinical opinion addressed the integration of palliative care into standard oncology practice at the time a person is diagnosed with metastatic or advanced cancer. The inclusion of Palliative Care among the National Quality Forum (NQF) framework represented a major advance in palliative care. NQF metrics include chemotherapy administered in the last 14 days of life, hospice less than 3 days before death, ICU or hospital admission, more than one Emergency Room visit in the last 30 days, and death in hospital. Although the use of hospice and other palliative care services has increased, many are enrolled in hospice less than 3 weeks before death. By improving quality of life, cost, and survival in patients with metastatic cancer, palliative care has increasing relevance for the care of patients with cancer. Methods: Retrospective chart review study of lung cancer patients diagnosed at VA from 2010-2013. Inclusion criteria: > 18 years of age with new diagnosis of metastatic lung cancer. Exclusion criteria: < 18 years of age, Stage I-III lung cancer. Results: Total of 125 patients were diagnosed with Stage IV lung cancer. The mean time from diagnosis to death was only 185 days (6.1 months). The VA NYHHS patients were more likely to visit the ED, be admitted to the hospital and ICU in the last 30 days of life, and subsequently die in the hospital. Conclusions: Several confounders were identified, including climate related closure of facilities (2012 Sandy storm), lack of social support, low ICU admission criteria, burial benefits for patients dying in a VA, and delay in transition to Hospice. Currently 392 patients with stage IV solid tumors diagnosed 2010-2014 are being studied. [Table: see text]
How to implement Institute of Medicine (IOM) 2013 recommendations on supportive oncology in community setting.
Authors: Weldon Christine B. , Trosman Julia Rachel , Berardi Rosa 
Published: February 2017

172 Background: The IOM 2013 report recommends supportive oncology services from diagnosis through survivorship and end of life. We examined what community institutions need in order to implement IOM recommendations. Funded by the Coleman Foundation. Methods: We conducted a survey of 35 institutions in a large urban area (13 cancer centers; 14 stand-alone cancer support centers, and 8 hospices) on institutional needs in implementing IOM recommendations. Results: Survey response rate was 100%. Respondents agreed on 8 of the top 10 priorities across the three organization types (Table). Local inter-institutional collaboration leveraging respective resources and facilitating care consistency across sites was the most frequently noted need. It was followed by the need for stratified care processes based on patient need and improved supportive oncology reimbursement. Priorities differed between Cancer Centers and other institution types on Consolidated screening tools* (p = .05, .09) and Care process for family / caregiver** (p = .006, .04). Conclusions: Supportive oncology care processes and tools are needed to implement IOM recommendations in the community. Our findings inform a roadmap for practical collaborative implementation of the IOM recommendations. Differing priorities across cancer institution types should be further explored and addressed within the roadmap. [Table: see text]
Patterns of storage, use, and disposal of opioids among cancer patients presenting to the emergency center.
Authors: Reddy Akhila Sunkepally , Silvestre Julio , De la Cruz Maxine Grace , Wu Jimin , Liu Diane D , Bruera Eduardo , Todd Knox H. 
Published: February 2017

184 Background: Approximately 75% of prescription opioid abusers obtain the drug from an acquaintance. Improper opioid storage, use, and disposal along with lack of patient education may lead to increased availability of the drug for abuse by others. Our aim was to determine the opioid storage, use, and disposal patterns in patients presenting to the emergency center (EC) of a comprehensive cancer center. Methods: We surveyed 113 cancer patients receiving opioids for at least 2 months and collected information regarding opioid use, storage, and disposal. Unsafe storage was defined as storing the opioids in plain sight and sharing or losing their opioids was defined as unsafe use. Results: The median age was 53 years, 55% were female, and 64% were white and 86% had advanced cancer. 19% of the patients had history of illicit drug use and 24% reported that drug abuse is prevalent in their neighborhood. 59% obtained the opioid from their oncologist and 6% believed they were prescribed more medication than required. Of the 113 respondents, 36% stored opioids in plain sight, 53% kept them hidden but unlocked, and only 15% locked their opioids. 73% agreed that they would use a lockbox to store their opioids if given one, 78% were unaware of proper opioid disposal methods, and 67% had unused opioids at home. Only 13% previously received education about safe disposal of opioids. Patients who reported that others have asked them for their pain medications (P = .004) and those who would use a lockbox if given one (P = .019) were more likely to keep them locked. 13 patients (12%) used opioids unsafely by either sharing (5%) or losing (8%) them. Patients who reported to being prescribed more pain pills than required (P = .032), others having asked them for their pain pills (P = .06), being unemployed (P = .07), and those who were unaware of drug take-back programs (P = .06) were more likely to participate in unsafe use. Overall, 77% (87) of the patients reported unsafe storage, unsafe use, or possessed unused opioids at home. Conclusions: A large number of cancer patients improperly and unsafely store, use, or dispose of opioids. More research is needed to determine whether patient education has an effect on minimizing prescription opioid abuse.