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  • 1
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 34, No. 26_suppl ( 2016-10-09), p. 195-195
    Abstract: 195 Background: Radiotherapy (RT) effectively palliates bone metastases, but relief may take weeks, frequently necessitating acute pain management (APM). NCCN Guidelines for Adult Cancer Pain (V2.2015) recommend initiation/titration of analgesics for patients with pain scale value (PSV) ≥ 4. We sought to evaluate how often symptomatic patients have analgesic regimens assessed and intervened upon at radiation oncology (RO) consult for bone metastases, and the impact of a dedicated palliative RO service on APM. Methods: We reviewed consult notes for 217 bone metastases patients treated with RT at Dana Farber Cancer Institute/Brigham & Women’s Hospital (DFCI/BWH) and University of California, San Francisco (UCSF) during June-July 2008, Jan-Feb 2010, Jan-Feb 2013, and June-July 2014, time periods before and after implementation in 2011 of a dedicated palliative RO service at DFCI/BWH. For symptomatic patients, rate of assessment of analgesic regimen was recorded. Among patients with PSV ≥ 4, rate of pain intervention was recorded. The impact of a palliative RO service on these rates was evaluated. Results: Median age was 63 and median KPS was 70. Median PSV for painful bone metastases was 5 (IQR 2-7); 51% had PSV ≥ 4. Among symptomatic patients, analgesic regimen was assessed for 44.5% (51.7% at DFCI/BWH and 28.1% at UCSF). Among patients with PSV ≥ 4, pain intervention occurred for 17.2% (20.5% for DFCI/BWH, 0% for UCSF). At DFCI/BWH, consultation by a dedicated palliative RO provider was associated with higher rate of assessment of analgesic regimen (82.4% vs 47.7%, p = 0.007). At DFCI/BWH, consultation by a palliative RO provider was associated with higher rate of pain intervention (31.2% vs 7.9%, p = 0.012). There was no difference in analgesic regimen assessment or intervention between non-dedicated palliative RO providers at DFCI/BWH and UCSF (p = 0.07 and 0.09, respectively). Conclusions: At two cancer centers, half of bone metastases patients seen for RT have PSV ≥ 4, yet a minority have analgesic assessment and intervention, indicating need for APM quality improvement in RO. An integrated palliative RO service was associated with improved assessment and management of acute pain per NCCN guidelines.
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
    RVK:
    RVK:
    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2016
    detail.hit.zdb_id: 2005181-5
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  • 2
    In: Radiotherapy and Oncology, Elsevier BV, Vol. 154 ( 2021-01), p. 145-153
    Type of Medium: Online Resource
    ISSN: 0167-8140
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2021
    detail.hit.zdb_id: 1500707-8
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  • 3
    In: Otology & Neurotology, Ovid Technologies (Wolters Kluwer Health), Vol. 44, No. 5 ( 2023-6), p. e333-e337
    Abstract: To compare hearing, tinnitus, balance, and quality-of-life treatment outcomes of petroclival meningioma and nonpetroclival cerebellopontine angle meningioma cohorts. Study Design A retrospective cohort study of 60 patients with posterior fossa meningiomas, 25 petroclival and 35 nonpetroclival, who were treated at a single tertiary care center between 2000 and 2020. Intervention A survey battery that included the Hearing Effort of the Tumor Ear, Speech and Spatial Qualities of Hearing, Tinnitus Functional Index, Dizziness Handicap Inventory (DHI), and Short Form Health Survey. Petroclival and nonpetroclival cohorts were matched for tumor size and demographic features. Main Outcome Measures Differences between groups in hearing, balance outcomes, and quality of life and patient factors that influence posttreatment quality of life. Results Petroclival meningioma patients reported poorer audiovestibular outcomes with a higher rate of deafness in the tumor ear (36.0% versus 8.6%, p = 0.032) and lower functional hearing by the Hearing Effort of the Tumor Ear, Speech and Spatial Qualities of Hearing (76.6 [6.1] versus 82.0 [4.4] , p 〈 0.001). Current dizziness rate was higher (48.0% versus 23.5%, p = 0.05), with more severe dizziness by DHI (18.4 [4.8] versus 5.7 [2.2] , p 〈 0.001). Both cohorts had similar high quality of life and low tinnitus severity indices. Quality-of-life Short Form Health Survey predictors were tumor size ( p = 0.012) and DHI ( p = 0.005) in multivariable analysis. Conclusions Hearing and dizziness treatment outcomes of petroclival meningioma are poorer relative to other posterior fossa meningiomas. Despite audiovestibular outcome distinctions, the overall posttreatment quality of life was high for both petroclival and nonpetroclival meningioma.
    Type of Medium: Online Resource
    ISSN: 1537-4505 , 1531-7129
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2023
    detail.hit.zdb_id: 2058738-7
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  • 4
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 40, No. 16_suppl ( 2022-06-01), p. 2007-2007
    Abstract: 2007 Background: Improvements in risk stratification of meningioma are needed to guide post-operative management and application of adjuvant therapy. Although profiling of DNA methylation, copy number variants (CNVs), RNA sequencing, and exome sequencing have better elucidated meningioma biology, these approaches have not revealed clinically tractable biomarkers for radiotherapy responses. In this study, we develop and validate a targeted gene expression biomarker to predict meningioma outcomes and benefit from radiotherapy. Methods: Targeted gene expression profiling was performed on a development set of 173 meningiomas (median follow-up 8.1 years) and a validation set of 331 consecutive meningiomas (median follow-up 6.1 years) treated at independent institutions (70% WHO grade 1, 24% WHO grade 2, 6% WHO grade 3). All patients underwent surgery (n = 504) with or without postoperative radiotherapy (n = 73 with radiation). Regularized Cox regression within the development set resulted in a continuous gene expression risk score for local freedom from recurrence (LFFR). The model (34 genes and 7 housekeeping genes) and thresholds for low, intermediate, and high-risk scores were locked and applied to the validation set. Results: The gene expression risk score outperformed WHO grade (validation 5-year LFFR delta-AUC 0.15, 95% CI 0.076-0.229, p = 0.001) and DNA methylation grouping (delta-AUC 0.075, 95% CI 0.006-0.130, p = 0.01) for LFFR, disease-specific survival, and OS, achieving a negative predictive value for recurrence at 5-years of 93.2%. The biomarker reclassified 35.8% of WHO grade 1 tumors as intermediate or high risk (5-year LFFR/OS 62%/79%), and 18.3% of WHO grade 2-3 tumors as low risk (5-year LFFR/OS 78%/100%). The biomarker was independently prognostic after accounting for WHO grade, extent of resection, primary versus recurrent presentation, CNV status, DNA methylation group, and Ki67 labeling index, and was predictive for LFFR after postoperative radiotherapy, with a hazard ratio of 0.41 for intermediate to high risk propensity-matched meningiomas (95% CI 0.2-0.9, p = 0.0002) versus 0.79 for low risk meningiomas (95% CI 0.1-8.8, p = 0.5182). Conclusions: Targeted gene expression profiling of 504 meningiomas resulted in a biomarker which improved discrimination of meningioma local recurrence, disease-specific survival, and overall survival, and also predicted benefit from radiotherapy.
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
    RVK:
    RVK:
    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2022
    detail.hit.zdb_id: 2005181-5
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  • 5
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 41, No. 16_suppl ( 2023-06-01), p. 1561-1561
    Abstract: 1561 Background: Delayed diagnosis and care of mental health disorders (MHD) is a significant challenge in the care for patients with cancer. The objective of this study was to use natural language processing (NLP) to identify words related to mental health documented in clinical notes surrounding the time of cancer diagnosis and assess their predictive ability of future, new MHD. Methods: This single institution cohort study consisted of patients diagnosed with cancer between January 2012 and November 2022. Cancer and MHD were identified based on ICD-10 codes obtained from deidentified electronic health record data. MHD included psychotic disorders (F20-29), mood disorders (F30-39), and anxiety disorders (F40-48). The clinical Text Analysis Knowledge Extraction System was applied to deidentified clinical notes, and symptoms mapped to SNOMED concepts relevant to mental health were identified. These mental health symptoms were aggregated in the 15 days preceding and 15 days following a first cancer diagnosis and analyzed across MHD status. Patient characteristics including sex, age, race, cancer, and insurance were also analyzed. Results: This cohort consisted of 64,010 patients with cancer who had no documented MHD prior to cancer diagnosis, with a majority being 40-64 years old (45.8%) or 65+ (43.7%) and identifying as male (53.0%) or white (60.2%). Most patients had prostate (12.5%), hematologic (10.8%), or breast (10.3%) cancer and private insurance (46.2%). 9,825 (15.3%) patients developed a newly documented MHD, with a median time of 139 days (IQR: 40-466) from cancer diagnosis. The top five most common mental health documented symptoms for all patients were normal mood (23.3%), mental state finding (17.9%), worried (10.2%), feeling content (9.9%), and cognitive function finding (6.6%). Those who had a future MHD had higher documented rates across all mental health symptoms. Multivariate cox proportional hazards model identified 18-39 years old, female, white, and Medicaid or Medicare insurance as independent factors associated with an increased risk of a future, new MHD. Prostate cancer was associated with lower risk of a future MHD. Panic (OR 2.1 [95% CI 1.8-2.4]), feeling nervous (1.9 [1.5-2.4] ), feeling guilt (1.9 [1.4-2.5]), mild anxiety (1.8 [1.4-2.4] ), and feeling frustrated (1.4 [1.2-1.6]) were identified as the symptoms most strongly associated with an increased risk of a future MHD. Conclusions: NLP extracted mental health symptoms documented in clinical notes correlated with an increased risk of documented MHD. Computational approaches may be tools for improving the timely diagnosis of MHD and referral to specialty services. Further w ork is needed to investigate potential disparities in documentation and management of care for patients with cancer who develop MHD, including delays between documentation and eventual diagnosis.
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
    RVK:
    RVK:
    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2023
    detail.hit.zdb_id: 2005181-5
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  • 6
    Online Resource
    Online Resource
    American Society of Clinical Oncology (ASCO) ; 2017
    In:  Journal of Clinical Oncology Vol. 35, No. 31_suppl ( 2017-11-01), p. 94-94
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 35, No. 31_suppl ( 2017-11-01), p. 94-94
    Abstract: 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.
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
    RVK:
    RVK:
    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2017
    detail.hit.zdb_id: 2005181-5
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  • 7
    Online Resource
    Online Resource
    Elsevier BV ; 2015
    In:  Brachytherapy Vol. 14, No. 2 ( 2015-03), p. 185-188
    In: Brachytherapy, Elsevier BV, Vol. 14, No. 2 ( 2015-03), p. 185-188
    Type of Medium: Online Resource
    ISSN: 1538-4721
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2015
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  • 8
    In: Brachytherapy, Elsevier BV, Vol. 15 ( 2016-05), p. S145-S146
    Type of Medium: Online Resource
    ISSN: 1538-4721
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2016
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  • 9
    Online Resource
    Online Resource
    American Society of Clinical Oncology (ASCO) ; 2016
    In:  Journal of Clinical Oncology Vol. 34, No. 26_suppl ( 2016-10-09), p. 201-201
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 34, No. 26_suppl ( 2016-10-09), p. 201-201
    Abstract: 201 Background: Radiation therapy (RT) provides an important role in the palliative care of patients with cancer. For patients with metastatic spinal cord compression not amenable to surgery, the value of timely palliative RT is well established; however, the value of the rapid application of RT for other chief complaints is less clear. The importance of palliative care service (PCS) involvement in patients treated with RT is becoming increasingly recognized and rapidly instituted RT could compromise this involvement. The purpose of this study was to assess the efficacy of emergent RT in alleviating symptoms in patients with cancer and to assess the extent of PCS in the management of patients treated with emergent RT. Methods: Patients treated with emergent RT were retrospectively identified through automated search of our institution’s radiation oncology electronic health record (EHR). Emergent RT was defined as treatment with RT in 48 hours or less from the time of simulation and flagged as emergent in the EHR by the radiotherapy team. Patients without a diagnosis of cancer were excluded from the study. For patients meeting inclusion criteria, data was collected regarding the chief complaint, completion of treatment, length of RT, and the primary outcomes of involvement of PCS and symptom relief. Results: From January to July 2015, 22 patients with cancer were treated with emergent RT. Prior to RT, 21 of 22 patients received other medical and/or procedural interventions. Sixty-four percent of patients were treated with 5 or fewer fractions and all but 2 patients completed RT. Symptoms improved in 73% of patients. PCS were involved in the care of 36% of patients. Conclusions: Emergent palliative RT provided symptom relief in the majority of patients; however, this study identified a lack of PCS involvement in the care of patients treated emergently. Study of long-term patient outcomes is needed. Future work should focus on developing clinical workflows that will better integrate involvement of PCS in the treatment of patients with palliative RT administered both emergently and non-emergently.
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
    RVK:
    RVK:
    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2016
    detail.hit.zdb_id: 2005181-5
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  • 10
    In: Brachytherapy, Elsevier BV, Vol. 22, No. 5 ( 2023-09), p. S39-
    Type of Medium: Online Resource
    ISSN: 1538-4721
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2023
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