Background.
Palliative care (PC) referrals are often delayed for patients with hematologic malignancies. We examined the differences in attitudes and beliefs toward PC referral between hematologic ...and solid tumor specialists and how their perception changed with use of the service name “supportive care” (SC).
Materials and Methods.
We randomly surveyed 120 hematologic and 120 solid tumor oncology specialists at our tertiary care cancer center to examine their attitudes and beliefs toward PC and SC referral.
Results.
Of the 240 specialists, 182 (76%) responded. Compared with solid tumor specialists, hematologic specialists were less likely to report that they would refer symptomatic patients with newly diagnosed cancer to PC (solid tumor, 43% vs. hematology, 21%; p = .002). A significantly greater proportion of specialists expressed that they would refer a patient with newly diagnosed cancer to SC than PC (solid tumor specialists: SC, 81% vs. PC, 43%; p < .001; hematology specialists: SC, 66% vs. PC, 21%; p < .001). The specialists perceived that PC was more likely than SC to be a barrier for referral (PC, 36% vs. SC, 3%; p < .001), to be synonymous with hospice (PC, 53% vs. SC, 6%; p < .001), to decrease hope (PC, 58% vs. SC, 8%; p < .001), and to be less appropriate for treatment of chemotherapy side effects (PC, 64% vs. SC, 19%; p < .001). On multivariate analysis, female clinicians (odds ratio OR, 4.5; 95% confidence interval CI, 1.3‐15.2; p = .02) and the perception that PC is a barrier for referral (OR, 3.0; 95% CI, 1.2‐7.6; p = .02) were associated with PC referral if the service name “SC” was used.
Conclusion.
Hematologic specialists were less likely to refer patients early in the disease trajectory and were conducive to referral with the service name SC instead of PC.
Implications for Practice:
The present survey of oncology specialists found that hematologic specialists were less likely than solid tumor specialists to report that they would refer symptomatic patients with newly diagnosed cancer to palliative care. However, both groups were significantly more willing to refer patients early in the disease trajectory if the service name “supportive care” were used instead of “palliative care.” These findings suggest that rebranding might help to overcome the stigma associated with palliative care and improve patient access to palliative care services.
This study examined the differences in attitudes and beliefs toward palliative care referral between hematologic and solid tumor specialists. Hematologic specialists were less likely to refer patients early in the disease trajectory and were conducive to referral with the service name “supportive care” instead of “palliative care.”
Abstract Context The Edmonton Symptom Assessment System (ESAS) is one of the most commonly used symptom batteries in clinical practice and research. Objectives We used the anchor-based approach to ...identify the minimal clinically important difference (MCID) for improvement and deterioration for ESAS physical, emotional, and total symptom distress scores. Methods In this multicenter prospective study, we asked patients with advanced cancer to complete their ESAS at the first clinic visit and at a second visit three weeks later. The anchor for MCID determination was Patient's Global Impression regarding their physical, emotional, and overall symptom burden (“better,” “about the same,” or “worse”). We identified the optimal sensitivity/specificity cutoffs for both improvement and deterioration for the three ESAS scores and also determined the within-patient changes. Results A total of 796 patients were enrolled from six centers. The ESAS scores had moderate responsiveness, with area under the receiver operating characteristic curve between 0.69 and 0.76. Using the sensitivity-specificity approach, the optimal cutoffs for ESAS physical, emotional, and total symptom distress scores were ≥3/60, ≥2/20, and ≥3/90 for improvement, and ≤−4/60, ≤−1/20, and ≤−4/90 for deterioration, respectively. These cutoffs had moderate sensitivities (59%–68%) and specificities (62%–80%). The within-patient change approach revealed the MCID cutoffs for improvement/deterioration to be 3/−4.3 for the physical score, 2.4/−1.8 for the emotional score, and 5.7/−2.9 for the total symptom distress score. Conclusion We identified the MCIDs for physical, emotional, and total symptom distress scores, which have implications for interpretation of symptom response in clinical trials.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Ionic electroactive polymer (IEAP) actuators that are driven by electrical stimuli have been widely investigated for use in practical applications. However, conventional electrodes in IEAP actuators ...have a serious drawback of poor durability under long-term actuation in open air, mainly because of leakage of the inner electrolyte and hydrated cations through surface cracks on the metallic electrodes. To overcome this problem, a top priority is developing new high-performance ionic polymer actuators with graphene electrodes that have superior mechanical, electrical conductivity, and electromechanical properties. However, the task is made difficultby issues such as the low electrical conductivity of graphene (G). The percolation network of silver nanowires (Ag-NWs) is believed to enhance the conductivity of graphene, while poly(3,4-ethylenedioxythiophene):polystyrene sulfonate (PEDOT:PSS), which exhibits excellent stability under ambient conditions, is expected to improve the actuation performance of IEAP actuators. In this study, we developed a very fast, stable, and durable IEAP actuator by employing electrodes made of a nanocomposite comprising PEDOT:PSS and graphene⁻Ag-NWs (P/(G⁻Ag)). The cost-effective P/(G⁻Ag) electrodes with high electrical conductivity displayed a smooth surface resulting from the PEDOT:PSS coating, which prevented oxidation of the surface upon exposure to air, and showedstrong bonding between the ionic polymer and the electrode surface. More interestingly, the proposed IEAP actuator based on the P/G⁻Ag electrode can be used in active biomedical devices, biomimetic robots, wearable electronics, and flexible soft electronics.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Primary ovarian neuroendocrine carcinoid tumors are extremely rare. However, their clinical course is good, and hence, fertility-sparing surgery is a feasible treatment option in cases of unilateral ...localized lesions. In this report, we present the case of a 20-year-old nulliparous woman who was diagnosed as having a primary ovarian neuroendocrine carcinoid tumor arising from a mature cystic teratoma. She underwent laparoscopic right ovarian cystectomy, and her postoperative recovery was uneventful. The patient has been under close observation over a 1-year follow-up period and has shown no evidence of tumor recurrence.
Survival predictions for advanced cancer patients impact many aspects of care, but the accuracy of clinician prediction of survival (CPS) is low. Prognostic tools such as the Palliative Prognostic ...Index (PPI) have been proposed to improve accuracy of predictions. However, it is not known if PPI is better than CPS at discriminating survival.
We compared the prognostic accuracy of CPS to PPI in patients with advanced cancer.
This was a prospective study in which palliative care physicians at our tertiary care cancer center documented both the PPI and CPS in hospitalized patients with advanced cancer. We compared the discrimination of CPS and PPI using concordance statistics, area under the receiver-operating characteristics curve (AUC), net reclassification index, and integrated discrimination improvement for 30-day survival and 100-day survival.
Two hundred fifteen patients were enrolled with a median survival of 109 days and a median follow-up of 239 days. The AUC for 30-day survival was 0.76 (95% CI 0.66–0.85) for PPI and 0.58 (95% CI 0.47–0.68) for CPS (P < 0.0001). Using the net reclassification index, 67% of patients were correctly reclassified using PPI instead of CPS for 30-day survival (P = 0.0005). CPS and PPI had similar accuracy for 100-day survival (AUC 0.62 vs. 0.64; P = 0.58).
We found that PPI was more accurate than CPS when used to discriminate survival at 30 days, but not at 100 days. This study highlights the reason and timing for using PPI to facilitate survival predictions.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Gastric endocervical adenocarcinoma is a rare type of cervical cancer. It was recently classified as a subtype of cervical cancer that exhibits an aggressive behavior with poor prognosis compared to ...other cancer types. Nevertheless, little is known about the clinical behavior of this cervical cancer subtype to establish a definitive treatment protocol. Herein, we report a case of poorly advanced gastric endocervical adenocarcinoma in a 47-year-old Korean woman who was suspected to have a borderline ovarian tumor and underwent a laparotomy. A gastric-type endocervical adenocarcinoma was diagnosed incidentally on histopathological examination.
Abstract Background Clinician prediction of survival (CPS) has low accuracy in the advanced cancer setting, raising the need for prediction models such as the palliative prognostic (PaP) score that ...includes a transformed CPS (PaP-CPS) and five clinical/laboratory variables (PaP-without CPS). However, it is unclear if the PaP score is more accurate than PaP-CPS, and whether PaP-CPS helps to improve the accuracy of PaP score. We compared the accuracy among PaP-CPS, PaP-without CPS and PaP-total score in patients with advanced cancer. Patients and methods In this prospective study, PaP score was documented in hospitalised patients seen by palliative care. We compared the discrimination of PaP-CPS versus PaP-total and PaP-without CPS versus PaP-total using four indices: concordance statistics, area under the receiver-operating characteristics curve (AUC), net reclassification index and integrated discrimination improvement for 30-day survival and 100-day survival. Results A total of 216 patients were enrolled with a median survival of 109 d (95% confidence interval CI 71–133 d). The AUC for 30-day survival was 0.57 (95% CI 0.47–0.67) for PaP-CPS, 0.78 (95% CI 0.7–0.87) for PaP-without CPS, and 0.73 (95% CI 0.64–0.82) for PaP-total score. PaP-total was significantly more accurate than PaP-CPS according to all four indices for both 30-day and 100-day survival (P < 0.001). PaP-without CPS was significantly more accurate than PaP-total for 30-day survival (P < 0.05). Conclusion We found that PaP score was more accurate than CPS, and the addition of CPS to the prognostic model reduced its accuracy. This study highlights the limitations of clinical gestalt and the need to use objective prognostic factors and models for survival prediction.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
Abstract Context Episodic breathlessness is common and debilitating in cancer patients. Objectives In this pilot study, we examined the effect of prophylactic fentanyl pectin nasal spray (FPNS) on ...exercise-induced dyspnea, physiologic function and adverse events. Methods In this parallel, double-blind randomized placebo-controlled trial, opioid-tolerant patients performed three six-minute walk tests (6MWT) to induce dyspnea. They were randomized to receive either FPNS (15-25% of total daily opioid dose each time) or placebo 20 minutes before the second and third 6MWTs. We compared dyspnea numeric rating scale (NRS, 0-10, primary outcome), walk distance, vital signs, neurocognitive function and adverse events between the first and second 6MWTs (T2-T1) and between the first and third 6MWTs (T3-T1). Results Twenty-four patients enrolled, with 96% completion. FPNS was associated with significant within-arm reduction in dyspnea NRS at rest (T2-T1: -0.9 95% confidence interval CI -1.7,-0.1; T3-T1: -1.3 95% CI -2.0,-0.5) and after six minutes (T2-T1: -2.0 95% CI -3.5,-0.6; T3-T1: -2.3 95% CI -4.0,-0.7), and longer walk distance (T2-T1 +23.8m 95% CI +1.3,+46.2m; T3-T1: +23.3m 95% CI -1.7,+48.2). In the placebo arm, we observed no significant change in walk distance nor dyspnea NRS at rest, but significant reduction in dyspnea NRS at 6 minutes (T2-T1: -1.7 95% CI -3.3,-0.1; T3-T1: -2.5 95% CI -4.2,-0.9). Vital signs, neurocognitive function and adverse effects did not differ significantly. Conclusion FPNS was safe, reduced dyspnea at rest and increased walk distance in before-after comparison. The placebo effect was substantial, which needs to be factored in future study designs.( clinicaltrials.gov registration: NCT01832402)
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
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