bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cancer pain in the emergency department: An EMR-based opioid dosing intervention and the effects on patient outcomes.
Authors: Coyne Christopher John , Miller Ryan , Dong Kelly , Shatsky Rebecca Arielle 
Published: June 2023

e24167 Background: Pain is a common reason for patients with cancer to seek care in the Emergency Department (ED). Many of these patients are on chronic opioids and may have developed opioid tolerance, which makes appropriate dosing challenging for emergency physicians. Therefore, we designed an electronic medical record (EMR) based best practice advisory (BPA) intervention to recommend appropriate opioid dosing in the ED, based on a patient’s prescription opioid use. Methods: We conducted a retrospective cohort study to evaluate our cancer pain intervention at two academic EDs from May 2020 to May 2022. Our novel BPA algorithm identified ED cancer patients who were taking prescription opioids with an EMR-calculated morphine equivalent daily dose (MEDD) of at least 100. If an ED provider ordered an opioid for one of these patients, the BPA would fire and recommend an opioid dose based on the patient’s individual MEDD. The ED provider would then have the option of accepting or cancelling the BPA. We compared outcomes based on whether patients received BPA-guided increased opioid dosing. We utilized the chi-squared test with an alpha of < 0.05 to assess the relationship between BPA-guided increased opioid dosing and pain scores, hospital admission rates and ED bounce-back rates (return visit within 7 days). Results: We identified 399 patients who met our inclusion criteria, representing 705 BPA alerts. Those patients that received increased opioid dosing were similar to those that did not, with respect to age, sex, race/ethnicity and ECOG score. Patients who received BPA-guided increased opioid dosing experienced a greater improvement in pain (72.5% vs 65.1%, p = 0.03) and were admitted less frequently (58.5% vs 63.9%, p = 0.04). However, among discharged patients, those that received increased opioid dosing bounced back to the ED more frequently (16.2% vs 7.7%, p < .01). Conclusions: This EMR-based BPA intervention was associated with improved pain scores and decreased admission rates among cancer patients visiting the ED. The same intervention, however, was associated with increased ED return visits within 7 days, suggesting that pain management strategies may need to be implemented or modified upon ED discharge to assure that patients’ symptoms are adequately managed at home.
Efficacy and safety of PEG-rhG-CSF versus rhG-CSF in preventing granulocytopenia in sarcoma patients receiving doxorubicin combined with ifosfamide: A prospective, randomized, non-inferiority phase II study.
Authors: Fan Li , Ye Ting , Wang Zhongliang , Cao Rubo , Wang Bicheng , Peng Ling , Chen Jing 
Published: June 2023

e24173 Background: Prophylactic use of rhG-CSF is routinely recommended in patients with a high risk of febrile neutropenia (FN) after chemotherapy. Currently, rhG-CSF is mostly used in clinical practice. However, PEG-rhG-CSF tends to be a substitute due to its convenience and long-acting effect. Regarding concerns about its efficacy and safety, whether PEG-rhG-CSF could be prophylactically used after these regimens with a high risk of FN is still in doubt. Doxorubicin combined with ifosfamide is commonly applied in sarcoma patients and is one of the most serious myelosuppressive chemotherapy regimens in solid tumors. We compared the efficacy and safety of PEG-rhG-CSF with rhG-CSF in the prevention of severe granulocytopenia and FN, in patients receiving this representative regimen. Methods: This was a single-center, prospective, randomized, crossover, non-inferiority phase II trial. Patients with sarcoma suitable for doxorubicin combined with ifosfamide treatment were enrolled. All patients received 2 cycles of chemotherapy and were randomly assigned to either the AOB group (PEG-rhG-CSF used in 1st cycle and rhG-CSF in 2nd cycle) or BOA group (rhG-CSF used in 1st cycle and PEG-rhG-CSF in 2nd cycle). Blood monitoring every other day until ANC ≥ 2×109/L in two consecutive tests. The primary endpoints were the frequency and duration of grade 4 granulocytopenia after prophylactic use of PEG-rhG-CSF and rhG-CSF respectively, the secondary endpoints were the frequency and duration of febrile neutropenia, and proportion of antibiotic use. Results: From Jan 1, 2018 to Aug 31, 2021, 70 patients were enrolled, 35 each in AOB and BOA. There were no statistical differences in the incidence and duration of grade 4 granulocytopenia (85.7% vs. 77.0%, p = 0.1; 1.34d vs. 1.41d, p = 0.70), the proportion and duration of febrile neutropenia (12.8% vs. 8.2%, p = 0.77; 0.6d vs. 0.8d, p = 0.74), and the proportion of antibiotics used (19.1% vs. 14.9%, p = 0.79) when comparing PEG-rhG-CSF vs. rhG-CSF in prophylactical use. The incidence of grade 4 granulocytopenia in both groups was comparable in 1st cycle (90.9% vs. 96.0%, p = 0.47), but in 2nd cycle it was significantly lower in AOB than that in BOA (54.5% vs. 88.0%, p = 0.01). The lowest value of ANC was higher in AOB in 2nd cycle (0.32G/L vs. 0.12G/L, p = 0.03). Conclusions: This study demonstrated PEG-rhG-CSF could prevent granulocytopenia and FN in sarcoma patients receiving doxorubicin combined with ifosfamide, with comparable efficacy and toxicities as rhG-CSF. Considering the convenience in use and patient compliance, PEG-rhG-CSF could be an effective and reasonable alternative to rhG-CSF. Clinical trial information: ChiCTR1900021945 .
Body image disturbances in adolescent and young adult patients with cancer confronting infertility risk and fertility preservation decisions.
Authors: Wytiaz Victoria A , Levin Nina , Tan Chiu Yi Joey , Stelmak Daria , Iannarino Nicholas , Zhang Anao , Ellman Erin , Herrel Lindsey A. , Moravek Molly , Walling Emily Byrnes , Chugh Rashmi , Zebrack Brad J. 
Published: June 2023

e24175 Background: Body image is a major psychosocial concern for all cancer patients but can affect the adolescent and young adult (AYA) population in distinct ways. Similarly, the prospect of infertility and the fertility preservation process can create additional stress during cancer treatment. Discussions regarding infertility inherently implicate the body and its reproductive function, but downstream effects on self-perception have not been previously described. The aim of this study was to better elucidate the relationship between oncofertility discussions and body image disturbances in the AYA cancer population. Methods: AYA cancer patients (n = 27) aged 12-25 years whose cancer treatment conferred the risk of infertility were recruited through electronic health record query at an NCI-Designated Comprehensive Cancer Center. Participants completed semi-structured interviews which were recorded, transcribed, and deductively coded for themes related to information needs, knowledge of treatment effects on fertility, and reproductive concerns after cancer. Emergent, inductive themes related to body image were identified. Results: Body image concerns, including those related to both physical appearance and body functioning, emerged as common themes. Specific concerns included 1) anticipating and coping with body changes, 2) discomfort in experiencing and discussing one’s own body, 3) fear of judgement, and 4) failing to meet both internal and external expectations of the body. Some participants expressed a sense of loss when learning about infertility risk and the emotional challenges associated with accepting this risk. Several respondents worried that they would be negatively judged by their peers for a perceived defect of the body. Still others struggled with facing the unknown regarding fertility preservation and the difficulty in sharing this information with loved ones and future romantic partners. Conclusions: AYA cancer patients experience a multitude of body image related disturbances when faced with the possibility of infertility and decisions regarding fertility preservation. In identifying and exploring these themes, future opportunities, and novel interventions for improving oncofertility practice and discussions among AYAs with a focus on body image positivity emerge. These include the dual involvement of multidisciplinary teams (oncology and reproductive medicine) at initial clinical consultation and frequent follow-up contact; AYA and oncofertility-specific peer support programs, both in-person and virtual; and early, frequent involvement of social workers and mental health providers experienced in both cancer care and reproductive medicine.
Information and decisional needs of patients (pts) with newly diagnosed advanced cancer in the hospital: A multi-level, mixed-methods study.
Authors: Reyes Kevin R , Wong Paul , Petrofsky Mary , Dai Annie , Pelayo Alyson , Brondfield Sam , Kwon Daniel H 
Published: June 2023

e24177 Background: Pt informed decision-making (IDM) is crucial in cancer care. Little is known about the informational and decisional needs of pts with newly diagnosed advanced cancer in the hospital, for whom unique IDM challenges may exist. Methods: A single-center, mixed-methods study of hospitalized pts with a newly diagnosed, treatment-naïve advanced solid malignancy; their caregivers; and outpatient medical oncologists was conducted from June to November 2022. At discharge, pts were surveyed for cancer type/stage knowledge, treatment knowledge & decisional conflict using the informed subscale & total Decisional Conflict Scale (DCS; scored 0-100, higher = more conflict) respectively, and information timing preferences. Post-discharge semi-structured interviews exploring information/decisional needs were conducted with pts or pt-caregiver dyads. Oncologists were surveyed about the knowledge of the most recent pt they saw who met aforementioned criteria. Quantitative data were analyzed using descriptive statistics and qualitative data using thematic analysis. Results: Of 25 pts approached, 20 (80%) completed the survey. Interviews were halted after 12 pts and 4 caregivers due to saturation. Fifteen (75%) pts knew their cancer type and 10 (50%) their stage. For the DCS, 13 (65%) scored > 37.5, which is linked with decision delay/regret; median informed subscale score was 66.7. Pts reported wanting to be informed as soon as possible (vs. later) about cancer type (90%), stage (85%), treatment options (80%) and prognosis (70%). Interview themes were cancer knowledge, cancer decisions, information needs/uncertainty, barriers/facilitators to information gathering during/post-hospitalization, decision-making barriers/facilitators, locus of control in decision-making, and goals. Of 46 oncologists approached, 32 (70%) completed the survey. Twenty-four (75%) reported that the pt was somewhat/very well-informed about cancer type, 15 (47%) stage, 18 (57%) treatment options and 9 (28%) prognosis. Themes from open-ended questions were inpatient information processing, outpatient care navigation/expectations, and low expectations of pt cancer knowledge. Oncologists recommended pt education, supportive care referrals, and inpatient-outpatient communication at discharge. Conclusions: Pts with an inpatient diagnosis of advanced cancer experience high decisional conflict and are not well-informed about cancer treatment and prognosis. Pts, caregivers, and oncologists identified numerous information/decisional needs and barriers/facilitators. Though some needs were due to barriers unique to hospitalization, pts did not perceive hospitalization as a barrier to IDM. Further studies should explore transitional interventions such as enhanced pt education, supportive care, and standardized, tailored handoffs to the outpatient team.
The impact of COVID-19 on anxiety among breast cancer survivors before, during and after the pandemic.
Authors: Tsui Edison , Reeves Katherine , Caruso Isabella , Makari-Judson Grace 
Published: June 2023

e24178 Background: The COVID-19 pandemic has caused unprecedented stressors on the mental health of patients with cancer as well as with cancer survivors. Little is known regarding anxiety among breast cancer survivors during and following the pandemic. Methods: We performed a cross-sectional study evaluating the mental health impacts of the COVID-19 pandemic on a cohort of breast cancer survivors (n = 1333). Between January and March 2022, participants enrolled in the Rays of Hope Breast Cancer Research Registry were invited to complete an online study questionnaire. We analyzed the data collected from a series of questions regarding outcomes and perspectives representing three distinct time periods: before (prior to March 2020), during (March 2020-June 2021) and after the COVID-19 pandemic (January-March 2022), based on the dates of the Massachusetts State of Emergency declaration. The COVID-19 Anxiety Scale (CAS) was used to measure anxiety specific to COVID-19. Generalized anxiety symptoms were measured using the Generalized Anxiety Disorder 7-item (GAD-7) scale. Multinomial logistic regression was used to identify factors related to increased or decreased anxiety symptoms. Results: A total of 272 independent participants (21.5%) completed the survey. Of these, 230 respondents with a confirmed history of breast cancer were included in the final analysis. While 26.2% met GAD-7 criteria for moderate to severe anxiety after the pandemic, only 13% self-reported a prior diagnosis of any mental health condition. Approximately 17% reported experiencing more anxiety symptoms after the pandemic compared to before. A history of smoking was associated with a higher likelihood of experiencing increased symptoms of generalized anxiety (OR = 1.97, 95% CI 0.93-4.14); whereas exercise frequency of at least three times per week was associated with experiencing a decrease in anxiety symptoms over this period (OR = 7.00, 95% CI 1.39-35.14). The CAS and reporting that the pandemic had a negative impact on cancer care were associated with a higher likelihood of increased generalized anxiety after the pandemic (OR = 2.21, 95% CI 1.19-4.09; OR = 3.05, 95% CI 1.06-8.83, respectively). Conclusions: Increased symptoms of anxiety were prevalent among breast cancer survivors during the pandemic and, in some, have not returned to pre-pandemic levels. Less than half of participants with symptoms meeting criteria for moderate to severe anxiety reported having a formal medical diagnosis, suggesting that clinically significant anxiety may be underrecognized in breast cancer survivors following the pandemic.
The voice of the breast cancer survivor: Implementation of survivorship needs assessment in an integrated health system.
Authors: Tahir Nayha , Wei Jenny , Zamani Constanza , Kurz Heather , Goler Nancy , DeYoung Claudia , Siegel Samantha , Shiraz Aida , Weldon Christine B. , Trosman Julia R. , Dixit Niharika , Liu Raymond 
Published: June 2023

e24180 Background: The population of breast cancer survivors in the US has reached 3.8 million in 2022. In times of standardized and guideline driven oncologic treatment, individual patients continue to have multitude of unique needs that may impact their long-term survival outcomes. To address whether assessment of patient needs is feasible and leads to actionable findings, we implemented a breast cancer survivor needs assessment with standardized documentation of actions taken in the electronic medical record. Methods: An adapted NCCN evaluation tool (Coleman Tool) was used in survivorship visits to assess the feasibility of needs assessment from January 2022 to June 2022 as part of a quality improvement project. The assessment was done either electronically via secure health portal prior to the visit or in person at the time of the visit. Patient, tumor, treatment characteristics as well as needs identified, and actions taken were abstracted from the electronic medical record. Fisher’s exact test used for comparisons. Results: Patients were ethnically diverse (43% White, 39% Asian, 13% Hispanic, African American 4%), English speaking (82%), and employed (50.5%). The median time from cancer diagnosis to needs assessment was 884 days. Most of the patients had Stage 1A (38.2%), were ER (91.7%) and PR (77.8%) positive and HER2 negative (73.7%). The majority underwent lumpectomy (66.4%), had radiation therapy (67.7%) and hormonal therapy (81.6%). Only 32.3% received chemotherapy. Most patients received some form of needs assessment (202 of 217, 94.0%), with 59 (29.2%) receiving pre-appointment electronic assessments with a 42.4% response rate. Major domains of needs reported by patients and actions taken are mentioned below in the table. Both pre and at visit assessments noted a high degree of treatment and physical needs that lead to subsequent actions (p value of 1.00 and 0.04 respectively). Conclusions: An adapted NCCN Needs Assessment Tool (Coleman Tool) is a practical and feasible method of assessing breast cancer survivors’ needs. The assessment can be done pre or at visit and can lead to actions which improve survivorship care. [Table: see text]
Differential efficacy of antidepressants in the treatment of hormone mediated depression in patients with ER+ breast cancer.
Authors: Kato Martha M , Martinez Constanza , Currier Maria , Rubens Muni B. 
Published: June 2023

e24181 Background: Tamoxifen (TAM) and aromatase inhibitors (AI) are associated with a high side-effect burden including depression and cognitive deficits which compromise quality of life and adherence to treatment. The aims of the study were to determine the efficacy of antidepressants (AD) with hormone mediated depression in ER+ breast cancer patients and to determine if any clinical variables predicted successful AD treatment response. Methods: A retrospective chart review of consecutive referrals to psycho-oncology of breast cancer patients on TAM or AI with new onset depression was conducted. Demographic variables, cancer stage and treatment, hormonal treatment, psychiatric history and AD treatment were collected. Assessments for depression, anxiety and cognitive disorders included clinical interviews, patient-rated scales [Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI)] and a clinician-rated scale [Montreal Cognitive Assessment (MoCA)]. These measures were done at baseline (before starting an AD) and follow-up to determine AD treatment response. Successful AD treatment is defined as ≥50% reduction in baseline BDI score, while remission of depression is defined as a BDI score < 8. Statistical analysis comparing clinical variables between AD responders and non-responders included Fischer’s exact test or chi-square, one-way ANOVA, t-test, and binary logistic regression to determine which variables predicted successful AD treatment response. Results: A sample of 40 ER+ breast cancer patients (mean age 55 years; 39 females, 1 male; 26 Hispanic, 14 non-Hispanic) included 18 on TAM and 22 on AI. AD included venlafaxine (N = 18), escitalopram (N = 9), bupropion (N = 4), mirtazapine (N = 4), sertraline (N = 3) and duloxetine (N = 2). Over 72% (29/40) of patients successfully responded to AD with a complete depression remission rate of 50% (20/40). Venlafaxine at a mean dose of 150 mg was significantly more effective (p = .013) in treating hormone-mediated depression when compared to selective serotonin reuptake inhibitors (SSRIs) and other AD (bupropion, mirtazapine). Specifically, 94% (17/18) of patients on venlafaxine successfully responded. Other variables such as cancer stage and treatment, demographics, psychiatric history, and specific hormonal therapy did not predict AD treatment response. Conclusions: Venlafaxine 150 mg daily yielded significantly higher rates of AD response and complete remission of depression in ER+ breast cancer patients with TAM-induced and AI-induced major depression. Venlafaxine was significantly more effective than SSRIs and atypical AD. This high rate of response is likely due to dual serotonin and norepinephrine reuptake inhibition achieved at 150 mg dosing. Venlafaxine can be safely administered with TAM.
Patient resilience and distress level prior to chemotherapy based on time estimation.
Authors: Kraleva Petya , Petrova Mila , Popov Teodor , Conev Nikolay Vladimirov , Dimitrova Eleonora , Ruseva Rossitza Krasteva , Changalova Aynura , Iliev Bozhidar , Nedeva Snezhina , Tatarov Tsvetan , Zhbantov Georgi , Hadjiev Rosen , Donev Ivan 
Published: June 2023

e24184 Background: Our prospective and multicentric study aimed to determine if the effects of breast cancer patients' resilience on their distress levels are mediated by the assessment of time before initiating neo/adjuvant chemotherapy. Methods: In 104 chemo-naive breast cancer patients, time estimation was evaluated by comparing each subject's prospective estimate of how rapidly one minute passed to the actual time. The Distress Thermometer of the National Comprehensive Cancer Network was used. The range of the scale is from 0 (no distress) to 10 (extreme distress). The Connor-Davidson Resilience Questionnaire (CD-RISC), a self-reported 10-item unidimensional scale, was utilized to measure resilience. Respondents rate statements on a 5-point Likert scale ranging from 0 (not true at all) to 4 (true nearly all the time). A higher score reflects greater resilience. Based on their RISC scores, patients were divided into three groups: low (up to the 33rd percentile), intermediate (between the 33rd and the 66th percentile), and high (over the 66th percentile). Patients' time estimations were similarly divided. Cronbach's α was 0.87 for all 10 items. Results: The mean age of the patients was 53.1±12.4 years. RISC scores correlated positively with time estimation (rho = 0.31, p = 0.002) and negatively with distress levels (rho = -0.445, p < 0.001). A significant negative correlation was observed between time estimation and distress levels (rho = -0.394, p < 0.001). Correspondence analysis revealed a significant association across the three matching groups of RISC score and time estimation (χ2 = 9.8, p = 0.044). The Jonckheere-Terpstra test revealed that patient estimates of time varied significantly between the three groups (p = 0.013). Using Hayes simple regression, we discovered that RISC scores were a significantly positive predictor of time estimation (b = 0.844, s.e. = 0.261, p < 0.0001). Both RISC score (b = -0.136, s.e. = 0.031, p < 0.0001) and time estimation (b = -0.041, s.e. = 0.011, p = 0.0005) were significant negative predictors for higher distress levels in the second regression. Conclusions: Via time estimation, patients' resilience influences distress levels prior to treatment initiation.