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LeBlanc, Thomas William

Overview:

Dr. LeBlanc is a medical oncologist, palliative care physician, and patient experience researcher.  His clinical practice focuses on the care of patients with hematologic malignancies, with a particular emphasis on myeloid conditions and acute leukemias including acute myeloid leukemia (AML), acute lymphocytic leukemia (ALL), myelodysplastic syndromes (MDS), and myeloproliferative neoplasms (MPNs / MPDs, CML), as well as some lymphomas and multiple myeloma.  He is an active member of the inpatient non-transplant hematologic malignancies care team, based on the 9100 ward of Duke Hospital.

His research interests converge on common issues faced by patients with cancer, particularly those with high-risk or relapsed/refractory hematologic malignancies. Issues of symptom burden and quality of life are of central importance in these settings, and may lead patients to face difficult decision-making scenarios. Dr. LeBlanc’s research explores the experience of patients and families in these settings, and aims to improve patients experiences living with blood cancers, including the involvement of specialist palliative care services to provide an extra layer of support along with their comprehensive cancer care.  

Dr. LeBlanc is the recipient of a Junior Career Development Award grant from the National Palliative Care Research Center (NPCRC), a Sojourns Scholars Leadership Award from the Cambia Health Foundation, and a Mentored Research Scholar Grant from the American Cancer Society. These grants have funded efforts to better understand the experience of patients living with AML, including studies of symptom burden, quality of life, distress, understanding of prognosis, and treatment decision-making. This work has been mentored by a team of expert researchers, including Drs. Amy Abernethy, James Tulsky, Karen Steinhauser, Kath Pollak, and Peter Ubel.  Dr. LeBlanc's work in palliative care research led to his recognition as an "Inspirational Leader under 40" by the American Academy of Hospice and Palliative Medicine (AAHPM), and was granted "fellow" status from the Academy in 2016. Dr. LeBlanc is the 2017-18 Chair of the ASCO Ethics Committee, and Chairs the Scientific Review Committee of the NIH/NINR-funded Palliative Care Research Cooperative Group (PCRC; www.palliativecareresearch.org). He represents the Duke Cancer Institute, a National Comprehensive Cancer Network (NCCN) member, on the NCCN Panel for Acute Myeloid Leukemia.

He completed residency training in Internal Medicine at Duke, as well as fellowships in Medical Oncology and Hospice and Palliative Medicine.  He graduated from the Duke University School of Medicine, also earning a Master of Arts degree in Philosophy during that time, and served as Chief Medical Resident at the Durham VA Medical Center.  He holds board certifications in Internal Medicine, Medical Oncology, and in Hospice and Palliative Medicine.  He is actively involved with teaching of medical students and housestaff at Duke, particularly with regards to issues of patient-doctor communication, and is mentoring several Duke trainees on research projects.

Positions:

Associate Professor of Medicine

Medicine, Hematologic Malignancies and Cellular Therapy
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

M.D. 2006

M.D. — Duke University

Intern

Duke University School of Medicine

Resident

Duke University School of Medicine

Chief Medical Resident

Duke University School of Medicine

Fellowship, Hospice And Palliative Medicine

Duke University School of Medicine

Fellow, Medical Oncology

Duke University School of Medicine

News:

Grants:

AC220-A-U302 trial

Administered By
Duke Clinical Research Institute
AwardedBy
Daiichi Sankyo Inc
Role
Principal Investigator
Start Date
July 01, 2016
End Date
August 07, 2020

Prognostic understanding and decision-making in acute myeloid leukemia (AML)

Administered By
Duke Cancer Institute
AwardedBy
American Cancer Society, Inc.
Role
Principal Investigator
Start Date
January 01, 2016
End Date
December 31, 2019

Treatment Switching Behavior among Multiple Myeloma Patients

Administered By
Duke Clinical Research Institute
AwardedBy
Amgen, Inc.
Role
Key Faculty
Start Date
August 30, 2018
End Date
August 29, 2019

Randomized Trial of Inpatient Palliative Care for Patients with Hematologic Malignancies

Administered By
Duke Cancer Institute
AwardedBy
Massachusetts General Hospital
Role
Principal Investigator
Start Date
August 09, 2018
End Date
July 31, 2019

Understanding Barriers to Oral Therapy Adherence in Adult/Older-Adult AML Patients (429 Oral)

Administered By
Duke Cancer Institute
AwardedBy
Carevive Systems, Inc.
Role
Principal Investigator
Start Date
February 01, 2019
End Date
June 30, 2019

Palliative Care Research Cooperative Group (PCRC) Refinement and Expansion

Administered By
Duke Cancer Institute
AwardedBy
University of Colorado Anschutz Medical Campus
Role
Chair
Start Date
July 01, 2018
End Date
June 30, 2019

Caregiver-Guided Pain Management Training in Palliative Care

Administered By
Psychiatry & Behavioral Sciences, Behavioral Medicine
AwardedBy
National Institutes of Health
Role
Co Investigator
Start Date
September 26, 2014
End Date
June 30, 2019

Palliative care and shared decision-making for patients with blood cancers

Administered By
Duke Cancer Institute
AwardedBy
Cambia Health Foundation
Role
Principal Investigator
Start Date
October 01, 2015
End Date
October 01, 2018

Refinement and Expansion of the Palliative Care Research Cooperative Group

Administered By
Duke Cancer Institute
AwardedBy
National Institutes of Health
Role
Investigator
Start Date
September 28, 2013
End Date
June 30, 2018

TRIADIC EXPECTATIONS: DECISION-MAKING IN ADVANCED CANCER

Administered By
Medicine, General Internal Medicine
AwardedBy
National Palliative Care Research Center
Role
Significant Contributor
Start Date
July 01, 2014
End Date
June 30, 2017

Prognostic Discordance in Oncology: what's behind the misunderstanding?

Administered By
Duke Clinical Research Institute
AwardedBy
National Palliative Care Research Center
Role
Principal Investigator
Start Date
July 01, 2013
End Date
June 30, 2015
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Publications:

Caregiver-guided pain coping skills training for patients with advanced cancer: Background, design, and challenges for the CaringPals study.

BACKGROUND/AIMS:Pain is a major concern of patients with advanced cancer and their caregivers. There is strong evidence that pain coping skills training interventions based on cognitive-behavioral principles can reduce pain severity and pain interference. However, few such interventions have been tested for patients with advanced cancer and their family caregivers. This study aims to test the efficacy of a caregiver-guided pain coping skills training protocol on patient and caregiver outcomes. METHODS:A total of 214 patients age ≥18 with Stage III-Stage IV cancer and moderate to severe pain, along with their family caregivers, are being identified and randomized with a 1:1 allocation to the caregiver-guided pain coping skills training intervention or enhanced treatment-as-usual. Dyads in both conditions receive educational resources on pain management, and the caregiver-guided pain coping skills training intervention includes three weekly 60-min sessions conducted with the patient-caregiver dyad via videoconference. Measures of caregiver outcomes (self-efficacy for helping the patient manage pain, caregiver strain, caregiving satisfaction, psychological distress) and patient outcomes (self-efficacy for pain management, pain intensity and interference, psychological distress) are collected at baseline and post-intervention. Caregiver outcomes are also collected 3 and 6 months following the patient's death. The study is enrolling patients from four tertiary care academic medical centers and one free-standing hospice and palliative care organization. The primary outcome is caregiver self-efficacy for helping the patient manage pain. RESULTS:This article describes challenges in the design and implementation of the CaringPals trial. Key issues for trial design include the identification and recruitment of patients with advanced cancer and pain, and the follow-up and collection of data from caregivers following the patient's death. CONCLUSION:The CaringPals trial addresses a gap in research in pain coping skills training interventions by addressing the unique needs of patients with advanced cancer and their caregivers. Findings from this study may lead to advances in the clinical care of patients with advanced cancer and pain, as well as a better understanding of the effects of training family caregivers to help patients cope with pain.

Authors
Porter, LS; Samsa, G; Steel, JL; Hanson, LC; LeBlanc, TW; Bull, J; Fischer, S; Keefe, FJ
MLA Citation
Porter, LS, Samsa, G, Steel, JL, Hanson, LC, LeBlanc, TW, Bull, J, Fischer, S, and Keefe, FJ. "Caregiver-guided pain coping skills training for patients with advanced cancer: Background, design, and challenges for the CaringPals study." Clinical Trials (London, England) (February 19, 2019): 1740774519829695-null.
PMID
30782014
Source
epmc
Published In
Clinical Trials
Publish Date
2019
Start Page
1740774519829695
DOI
10.1177/1740774519829695

Pruritus in patients with solid tumors: an overlooked supportive care need.

PURPOSE:Pruritus is a common symptom in cutaneous malignancies, but its impact on patients with solid tumors is unclear. We explored the impact and management of pruritus in patients with solid tumors, using patient-reported outcomes (PRO) data from a real-world registry. METHODS:From 2006 to 2011, patients seen in the Duke Cancer Institute reported their symptoms via the Patient Care Monitor v2.0, a validated PRO tool that includes a 0-10-point question about pruritus severity. From > 25,000 encounters, 203 patients reported severe pruritus (> 6/10) on at least one visit and 506 total visits were abstracted where patients reported either moderate or severe pruritus (> 3/10). From this cohort, we abstracted demographics, diagnosis, stage, cancer therapy, anti-pruritic therapy, and clinicians' responses. RESULTS:Mean age was 59.8 (SD 13.3), 134 (66%) were female, 125 (62%) were Caucasian, and 65 (32%) were African American. Breast cancer was the most common tumor (36.5%), followed by lung cancer (23.2%). Mean pruritus severity score was 6.8 (SD 1.8) for patients on chemotherapy, 6.9 (SD 1.8) for patients on targeted therapy alone or in combination, and 7.1(SD 1.8) for patients off treatment. Overall, 67% of patients reported at least two episodes of moderate-severe pruritus (mean # of visits 4.2 (SD 2.7)). Despite frequent report of severe and persistent pruritus, this was mentioned in just 28% of clinician notes and an intervention was recommended/prescribed in only 7% of visits. CONCLUSIONS:Pruritus is an under-addressed symptom in patients with solid tumors. Additional research is needed to understand the burden of pruritus in affected populations.

Authors
Vallely, JJ; Hudson, KE; Locke, SC; Wolf, SP; Samsa, GP; Abernethy, AP; LeBlanc, TW
MLA Citation
Vallely, JJ, Hudson, KE, Locke, SC, Wolf, SP, Samsa, GP, Abernethy, AP, and LeBlanc, TW. "Pruritus in patients with solid tumors: an overlooked supportive care need." Supportive Care in Cancer : Official Journal of the Multinational Association of Supportive Care in Cancer (February 14, 2019).
PMID
30762144
Source
epmc
Published In
Supportive Care in Cancer : Official Journal of the Multinational Association of Supportive Care in Cancer
Publish Date
2019
DOI
10.1007/s00520-019-04693-5

Associations between Anxiety, Poor Prognosis, and Accurate Understanding of Scan Results among Advanced Cancer Patients.

BACKGROUND:Routine imaging ("scan") results contain key prognostic information for advanced cancer patients. Yet, little is known about how accurately patients understand this information, and whether psychological states relate to accurate understanding. OBJECTIVE:To determine if patients' sadness and anxiety, as well as results showing poorer prognosis, are associated with patients' understanding of scan results. DESIGN:Archival contrasts performed on multi-institutional cohort study data. SUBJECTS:Advanced cancer patients whose disease progressed after at least one chemotherapy regimen (N = 94) and their clinicians (N = 28) were recruited before an oncology appointment to discuss routine scan results. MEASUREMENTS:In preappointment structured interviews, patients rated sadness and anxiety about their cancer. Following the appointment, patients and clinicians reported whether the imaging results discussed showed progressive, improved, or stable disease. RESULTS:Overall, 68% of patients reported their imaging results accurately, as indicated by concordance with their clinician's rating. Accuracy was higher among patients whose results indicated improved (adjusted odds ratio [AOR] = 4.12, p = 0.02) or stable (AOR = 2.59, p = 0.04) disease compared with progressive disease. Patients with greater anxiety were less likely to report their imaging results accurately than those with less anxiety (AOR = 0.09, p = 0.003); in contrast, those with greater sadness were more likely to report their results accurately than those with less sadness (AOR = 5.23, p = 0.03). CONCLUSIONS:Advanced cancer patients with higher anxiety and those with disease progression may need more help understanding or accepting their scan results than others.

Authors
Derry, HM; Maciejewski, PK; Epstein, AS; Shah, MA; LeBlanc, TW; Reyna, V; Prigerson, HG
MLA Citation
Derry, HM, Maciejewski, PK, Epstein, AS, Shah, MA, LeBlanc, TW, Reyna, V, and Prigerson, HG. "Associations between Anxiety, Poor Prognosis, and Accurate Understanding of Scan Results among Advanced Cancer Patients." Journal of Palliative Medicine (February 6, 2019).
PMID
30724692
Source
epmc
Published In
Journal of Palliative Medicine
Publish Date
2019
DOI
10.1089/jpm.2018.0624

Dose-intense chemoimmunotherapy plus radioimmunotherapy in high-risk diffuse large B-cell lymphoma and mantle cell lymphoma: a phase II study.

Authors
Hudson, KE; Rizzieri, D; Thomas, SM; LeBlanc, TW; Powell, Z; Diehl, L; Moore, JO; DeCastro, C; Beaven, AW
MLA Citation
Hudson, KE, Rizzieri, D, Thomas, SM, LeBlanc, TW, Powell, Z, Diehl, L, Moore, JO, DeCastro, C, and Beaven, AW. "Dose-intense chemoimmunotherapy plus radioimmunotherapy in high-risk diffuse large B-cell lymphoma and mantle cell lymphoma: a phase II study." British Journal of Haematology 184.4 (February 2019): 647-650. (Letter)
PMID
29468651
Source
epmc
Published In
British Journal of Haematology
Volume
184
Issue
4
Publish Date
2019
Start Page
647
End Page
650
DOI
10.1111/bjh.15138

The experiences of older caregivers of cancer patients following hospital discharge.

PURPOSE:This study addressed the experiences of older caregivers of cancer patients in the 2 weeks following a hospital discharge. It sought to understand the challenges they face in providing supportive care to patients at home. METHODS:Qualitative descriptive interviews with a narrative approach were conducted with each caregiver at 1 and 2 weeks following the patient's discharge from the hospital. A thematic analysis approach was used to identify the themes that emerged from the caregiver interviews. RESULTS:Caregivers were primarily Caucasian (77%), were mostly 68 years of age or older (62%), and were primarily caring for a spouse (69%). Three key themes emerged from the qualitative analysis: caregiver and patient wellness are connected, caregivers' struggle with control issues, and challenges in communication with health professionals. CONCLUSIONS:These findings highlight psychosocial changes that caregivers experience over the 2-week time period following hospital discharge. Implications include the need to identify interventions to better prepare caregivers for the post-discharge period.

Authors
Schwartz, AJ; Riedel, RF; LeBlanc, TW; Desai, D; Jenkins, C; Mahoney, E; Humphreys, J; Hendrix, CC
MLA Citation
Schwartz, AJ, Riedel, RF, LeBlanc, TW, Desai, D, Jenkins, C, Mahoney, E, Humphreys, J, and Hendrix, CC. "The experiences of older caregivers of cancer patients following hospital discharge." Supportive Care in Cancer : Official Journal of the Multinational Association of Supportive Care in Cancer 27.2 (February 2019): 609-616.
PMID
30027328
Source
epmc
Published In
Supportive Care in Cancer : Official Journal of the Multinational Association of Supportive Care in Cancer
Volume
27
Issue
2
Publish Date
2019
Start Page
609
End Page
616
DOI
10.1007/s00520-018-4355-2

Patient-Clinician Discordance in Perceptions of Treatment Risks and Benefits in Older Patients with Acute Myeloid Leukemia.

BACKGROUND:Older patients (≥60 years) with acute myeloid leukemia (AML) face difficult decisions regarding treatment with "intensive" chemotherapy that carries significant toxicity for a small chance of a cure versus "nonintensive" chemotherapy to control the disease, but with fewer side effects. However, studies of how these patients understand the risks and benefits of such treatments are lacking. METHODS:We conducted a longitudinal study of older patients newly diagnosed with AML assessing patients' (n = 100) and oncologists' (n = 11) perceptions of treatment-related mortality at enrollment and prognosis at 1 month. We examined concordance between patients' and oncologists' perceptions using Cohen's kappa (κ < 0.10 indicates little/no concordance). RESULTS:We enrolled patients within 72 hours of initiating intensive (n = 50) or nonintensive (n = 50) chemotherapy. Whereas 91% of patients reported that they were "somewhat" to "extremely likely" to die from treatment, oncologists estimated that only 12% were at high risk of dying because of treatment (κ = -0.09). Ninety percent of patients reported that they were "somewhat" or "very likely" to be cured of their AML, whereas oncologists estimated this chance of cure for only 31% of patients (κ = 0.05). Among patients receiving intensive chemotherapy, 98% reported that they were "somewhat" or "very likely" to be cured, whereas their oncologists estimated this likelihood of cure for only 49% (κ = 0.04); among those receiving nonintensive chemotherapy and their clinicians, these proportions were 82% and 13%, respectively (κ = 0.03). Patients who indicated a lower likelihood of cure reported significantly higher depression symptoms (p = .03). CONCLUSION:Older patients with AML overestimate the risks and benefits of treatment. Interventions to facilitate communication and enhance patients' understanding of the goals of therapy and treatment risk are needed. IMPLICATIONS FOR PRACTICE:Older patients with acute myeloid leukemia (AML) are confronted with challenging decisions regarding treatment with "intensive" chemotherapy that carries significant toxicity for a small chance of a cure versus "nonintensive" chemotherapy to control the disease, but with fewer side effects. A clear understanding of the likely outcome and risks of the various treatment strategies is essential for these patients to make informed decisions about their care. This article reports that older patients with AML overestimate both the risks and benefits of treatment and have substantial misperceptions about their prognosis. Interventions to enhance patients' understanding of their prognosis and treatment risk are needed.

Authors
El-Jawahri, A; Nelson-Lowe, M; VanDusen, H; Traeger, L; Abel, GA; Greer, JA; Fathi, A; Steensma, DP; LeBlanc, TW; Li, Z; DeAngelo, D; Wadleigh, M; Hobbs, G; Foster, J; Brunner, A; Amrein, P; Stone, RM; Temel, JS
MLA Citation
El-Jawahri, A, Nelson-Lowe, M, VanDusen, H, Traeger, L, Abel, GA, Greer, JA, Fathi, A, Steensma, DP, LeBlanc, TW, Li, Z, DeAngelo, D, Wadleigh, M, Hobbs, G, Foster, J, Brunner, A, Amrein, P, Stone, RM, and Temel, JS. "Patient-Clinician Discordance in Perceptions of Treatment Risks and Benefits in Older Patients with Acute Myeloid Leukemia." The Oncologist 24.2 (February 2019): 247-254.
PMID
30139841
Source
epmc
Published In
The Oncologist
Volume
24
Issue
2
Publish Date
2019
Start Page
247
End Page
254
DOI
10.1634/theoncologist.2018-0317

Integrated outpatient palliative care for patients with advanced cancer: A systematic review and meta-analysis.

BACKGROUND::Despite increasing emphasis on integration of palliative care with disease-directed care for advanced cancer, the nature of this integration and its effects on patient and caregiver outcomes are not well-understood. AIM::We evaluated the effects of integrated outpatient palliative and oncology care for advanced cancer on patient and caregiver outcomes. DESIGN::Following a standard protocol (PROSPERO: CRD42017057541), investigators independently screened reports to identify randomized controlled trials or quasi-experimental studies that evaluated the effect of integrated outpatient palliative and oncology care interventions on quality of life, survival, and healthcare utilization among adults with advanced cancer. Data were synthesized using random-effects meta-analyses, supplemented with qualitative methods when necessary. DATA SOURCES::English-language peer-reviewed publications in PubMed, CINAHL, and Cochrane Central through November 2016. We subsequently updated our PubMed search through July 2018. RESULTS::Eight randomized-controlled and two cluster-randomized trials were included. Most patients had multiple advanced cancers, with median time from diagnosis or recurrence to enrollment ranging from 8 to 12 weeks. All interventions included a multidisciplinary team, were classified as "moderately integrated," and addressed physical and psychological symptoms. In a meta-analysis, short-term quality of life improved, symptom burden improved, and all-cause mortality decreased. Qualitative analyses revealed no association between integration elements, palliative care intervention elements, and intervention impact. Utilization and caregiver outcomes were often not reported. CONCLUSIONS::Moderately integrated palliative and oncology outpatient interventions had positive effects on short-term quality of life, symptom burden, and survival. Evidence for effects on healthcare utilization and caregiver outcomes remains sparse.

Authors
Fulton, JJ; LeBlanc, TW; Cutson, TM; Porter Starr, KN; Kamal, A; Ramos, K; Freiermuth, CE; McDuffie, JR; Kosinski, A; Adam, S; Nagi, A; Williams, JW
MLA Citation
Fulton, JJ, LeBlanc, TW, Cutson, TM, Porter Starr, KN, Kamal, A, Ramos, K, Freiermuth, CE, McDuffie, JR, Kosinski, A, Adam, S, Nagi, A, and Williams, JW. "Integrated outpatient palliative care for patients with advanced cancer: A systematic review and meta-analysis." Palliative Medicine 33.2 (February 2019): 123-134.
PMID
30488781
Source
epmc
Published In
Palliative Medicine
Volume
33
Issue
2
Publish Date
2019
Start Page
123
End Page
134
DOI
10.1177/0269216318812633

Disparities in place of death for patients with hematological malignancies, 1999 to 2015.

Patients with hematologic malignancies (HMs) often receive aggressive end-of-life care and less frequently use hospice. Comprehensive longitudinal reporting on place of death, a key quality indicator, is lacking. Deidentified death certificate data were obtained via the National Center for Health Statistics for all HM deaths from 1999 to 2015. Multivariate regression analysis (MVA) was used to test for disparities in place of death associated with sociodemographic variables. During the study period, there were 951 435 HM deaths. Hospital deaths decreased from 54.6% in 1999 to 38.2% in 2015, whereas home (25.9% to 32.7%) and hospice facility deaths (0% to 12.1%) increased (all P < .001). On MVA of all cancers, HM patients had the lowest odds of home or hospice facility death (odds ratio [OR], 0.55; 95% confidence interval, 0.54-0.55). Older age (40-64 years: OR, 1.34; ≥65 years: OR, 1.89), being married (OR, 1.62), and having myeloma (OR, 1.34) were associated with home or hospice facility death, whereas being black or African American (OR, 0.68), Asian (OR, 0.58), or Hispanic (OR, 0.84) or having chronic leukemia (OR, 0.83) had decreased odds of dying at home or hospice (all P < .001). In conclusion, despite hospital deaths decreasing over time, patients with HMs remained more likely to die in the hospital than at home.

Authors
Chino, F; Kamal, AH; Chino, J; LeBlanc, TW
MLA Citation
Chino, F, Kamal, AH, Chino, J, and LeBlanc, TW. "Disparities in place of death for patients with hematological malignancies, 1999 to 2015." Blood Advances 3.3 (February 2019): 333-338.
PMID
30709864
Source
epmc
Published In
Blood Advances
Volume
3
Issue
3
Publish Date
2019
Start Page
333
End Page
338
DOI
10.1182/bloodadvances.2018023051

What’s the Deal with Blood Cancers? Navigating a New Frontier in Palliative Cancer Care (TH313)

Authors
LeBlanc, T; El-Jawahri, A; Roeland, E; Webb, J
MLA Citation
LeBlanc, T, El-Jawahri, A, Roeland, E, and Webb, J. "What’s the Deal with Blood Cancers? Navigating a New Frontier in Palliative Cancer Care (TH313).": Elsevier BV, February 2019.
Source
crossref
Published In
Journal of Pain and Symptom Management
Volume
57
Issue
2
Publish Date
2019
Start Page
371
End Page
371
DOI
10.1016/j.jpainsymman.2018.12.045

Oncologist in My Pocket: What the Hospice & Palliative Clinician Needs to Know About Hematology/Oncology and Radiation Oncology (P20)

Authors
Newport, K; Sivendran, S; Jones, J; LeBlanc, T
MLA Citation
Newport, K, Sivendran, S, Jones, J, and LeBlanc, T. "Oncologist in My Pocket: What the Hospice & Palliative Clinician Needs to Know About Hematology/Oncology and Radiation Oncology (P20).": Elsevier BV, February 2019.
Source
crossref
Published In
Journal of Pain and Symptom Management
Volume
57
Issue
2
Publish Date
2019
Start Page
361
End Page
361
DOI
10.1016/j.jpainsymman.2018.12.026

Palliative Care Physician Comfort (and Discomfort) with Discussing Prognosis in Hematologic Diseases: Results of a Nationwide Survey (SA528B)

Authors
Santivasi, W; Wu, K; Litzow, M; LeBlanc, T; Strand, J
MLA Citation
Santivasi, W, Wu, K, Litzow, M, LeBlanc, T, and Strand, J. "Palliative Care Physician Comfort (and Discomfort) with Discussing Prognosis in Hematologic Diseases: Results of a Nationwide Survey (SA528B).": Elsevier BV, February 2019.
Source
crossref
Published In
Journal of Pain and Symptom Management
Volume
57
Issue
2
Publish Date
2019
Start Page
454
End Page
454
DOI
10.1016/j.jpainsymman.2018.12.205

Korean Physicians' Perspectives on Prognostication in Palliative Care: A Qualitative Study.

BACKGROUND::Prognostication is an essential component of palliative care for patients with advanced cancer but also poses challenges. Little is known about physicians' perspectives on prognostication and prognostic tools used in palliative care practice in Eastern countries. OBJECTIVES::To explore Korean physicians' perspectives and experiences with prognostication in their palliative care practices. METHODS::Semi-structured interviews were conducted in Korea in 11 palliative care physicians. A constant comparative and grounded theory approach was used to derive themes from interview transcripts. RESULTS::Participants on average had 6.4 (SD = 4.5, range 0.5-15) years of hospice and palliative care experience. We identified 4 main themes about prognostication: (1) the importance of prognostication (to help patients and their families prepare for death, to determine the appropriate time of transition to hospice care, to facilitate appropriate decision making, and to facilitate communication with patients and their families); (2) difficulties of prognostication (discomfort estimating the exact date of death); (3) basis of prognostication (clinical prediction of survival as well as prognostic scores); and (4) areas for further research (need for a simpler scoring system or parameters to predict survival with greater certainty). CONCLUSION::Palliative care physicians in Korea reported similar perceptions about the role and challenges inherent in prognostication compared to clinicians in Western cultures. However, they emphasize the need to predict final days to keep families with dying patients, reflecting family-centered aspects of Asian culture. They reported frustrations with inaccurate prognostication schemas and called for the development of simpler, more accurate predictors as a focus of future research.

Authors
Lee, ES; Suh, S-Y; LeBlanc, TW; Himchack, SH; Lee, SS; Kim, Y; Ahn, H-Y
MLA Citation
Lee, ES, Suh, S-Y, LeBlanc, TW, Himchack, SH, Lee, SS, Kim, Y, and Ahn, H-Y. "Korean Physicians' Perspectives on Prognostication in Palliative Care: A Qualitative Study." The American Journal of Hospice & Palliative Care (January 27, 2019): 1049909118824542-null.
PMID
30686024
Source
epmc
Published In
The American Journal of Hospice & Palliative Care
Publish Date
2019
Start Page
1049909118824542
DOI
10.1177/1049909118824542

Shifting paradigms in the treatment of older adults with AML

© 2019 The treatment of acute myeloid leukemia has been associated with dismal outcomes despite available therapies. The morbidity and mortality associated with acute myeloid leukemia (AML) are most profound in older patients who account for the majority of cases. The 5-year survival of AML patients over age 65 years has remained 5% for decades. However, for the first time since the development of 7+3 induction chemotherapy in the 1970s, there is reason to believe that outcomes can and will improve. The understanding of the biology of AML has led to the development of targeted therapies that have shown great promise in this regard. Therapeutic interventions can lead to meaningful responses with improvement in hematopoietic function and much more acceptable toxicity profiles compared with intensive therapy. The therapeutic paradigms for older AML patients have shifted. Nevertheless, the diagnosis most often comes late in life, when patients are more likely to have impaired functional status and suffer from other comorbid illnesses. Therefore, the oncologist must be fully engaged with the patient, discussing goals of therapy and end-of-life issues, in a shared decision making process.

Authors
LeBlanc, TW; Erba, HP
MLA Citation
LeBlanc, TW, and Erba, HP. "Shifting paradigms in the treatment of older adults with AML." Seminars in Hematology (January 1, 2019). (Review)
Source
scopus
Published In
Seminars in Hematology
Publish Date
2019
DOI
10.1053/j.seminhematol.2019.02.002

Let's Talk About Those Herbs You Are Taking: Ethical Considerations for Communication With Patients With Cancer About Complementary and Alternative Medicine.

Oncologists face ethical challenges when patients use potentially harmful complementary and alternative medicine in addition to or instead of conventional treatments for their cancer. For example, a patient may forego effective cancer treatment in favor of alternative therapies and suffer significant harm as a result. Similarly, false beliefs about the efficacy of complementary therapies may complicate the process of shared decision making about cancer treatment. In this vignette, we discuss clinicians' obligations and provide recommendations for ethically sound communication practices in this clinical context.

Authors
Tenner, L; Hlubocky, FJ; Blanke, CD; LeBlanc, TW; Marron, JM; McGinnis, MM; Spence, RA; Taylor, LP
MLA Citation
Tenner, L, Hlubocky, FJ, Blanke, CD, LeBlanc, TW, Marron, JM, McGinnis, MM, Spence, RA, and Taylor, LP. "Let's Talk About Those Herbs You Are Taking: Ethical Considerations for Communication With Patients With Cancer About Complementary and Alternative Medicine." Journal of Oncology Practice 15.1 (January 2019): 44-49.
PMID
30629899
Source
epmc
Published In
J Oncol Pract
Volume
15
Issue
1
Publish Date
2019
Start Page
44
End Page
49
DOI
10.1200/jop.18.00432

A New Frontier for Palliative Care: The Need to Train Palliative-Oncology Subspecialists

Authors
Webb, JA; Kamal, AH; LeBlanc, TW
MLA Citation
Webb, JA, Kamal, AH, and LeBlanc, TW. "A New Frontier for Palliative Care: The Need to Train Palliative-Oncology Subspecialists." Journal of Palliative Medicine 21.12 (December 1, 2018): 1679-1680. (Letter)
Source
scopus
Published In
Journal of Palliative Medicine
Volume
21
Issue
12
Publish Date
2018
Start Page
1679
End Page
1680
DOI
10.1089/jpm.2018.0421

What do transplant physicians think about palliative care? A national survey study.

BACKGROUND:Despite its established benefits, palliative care (PC) is rarely utilized for hematopoietic stem cell transplant (HSCT) patients. We sought to examine transplant physicians' perceptions of PC. METHODS:We conducted a cross-sectional survey of transplant physicians recruited from the American-Society-for-Blood-and-Marrow-Transplantation. Using a 28-item questionnaire adapted from prior studies, we examined physicians' access to PC services, and perceptions of PC. We computed a composite score of physicians' attitudes about PC (mean = 16.9, SD = 3.37) and explored predictors of attitudes using a linear mixed model. RESULTS:277/1005 (28%) of eligible physicians completed the questionnaire. The majority (76%) stated that they trust PC clinicians to care for their patients, but 40% felt that PC clinicians do not have enough understanding to counsel HSCT patients about their treatments. Most endorsed that when patients hear the term PC, they feel scared (82%) and anxious (76%). Nearly half (46%) reported that the service name 'palliative care' is a barrier to utilization. Female sex (β = 0.85, P = .024), having <10 years of clinical practice (β = 1.39, P = .004), and perceived quality of PC services (β = 0.60, P < .001) were all associated with a more positive attitude towards PC. Physicians with a higher sense of ownership over their patients' PC issues (β = -0.36, P < .001) were more likely to have a negative attitude towards PC. CONCLUSIONS:The majority of transplant physicians trust PC, but have substantial concerns about PC clinicians' knowledge about HSCT and patients' perception of the term 'palliative care'. Interventions are needed to promote collaboration, improve perceptions, and enhance integration of PC for HSCT recipients.

Authors
El-Jawahri, A; LeBlanc, TW; Burns, LJ; Denzen, E; Meyer, C; Mau, L-W; Roeland, EJ; Wood, WA; Petersdorf, E
MLA Citation
El-Jawahri, A, LeBlanc, TW, Burns, LJ, Denzen, E, Meyer, C, Mau, L-W, Roeland, EJ, Wood, WA, and Petersdorf, E. "What do transplant physicians think about palliative care? A national survey study." December 2018.
PMID
30289980
Source
epmc
Published In
Cancer
Volume
124
Issue
23
Publish Date
2018
Start Page
4556
End Page
4566
DOI
10.1002/cncr.31709

Hemato-oncology and palliative care teams: is it time for an integrated approach to patient care?

PURPOSE OF REVIEW:Integrated palliative care for those with advanced solid tumors yields significant benefits in patient and caregiver outcomes. However, most palliative care clinical trials have excluded patients with hematologic malignancies. There is growing interest in whether integrated palliative care may yield similar benefits in hematologic malignancy patients and caregivers, but there has been little direct evidence of benefit in this population. This review summarizes new data on palliative care issues in hematologic malignancies, published in the preceding 12 months. RECENT FINDINGS:Most newly published evidence on this topic from the last year is descriptive of unmet needs, poor end-of-life care outcomes or unique differences and issues posed by hematologic malignancies as compared to solid tumors. A few articles describe models of collaborative care in hematologic malignancies, and just one describes the impact of an integrated palliative care intervention on patient and caregiver outcomes. Several studies point to transfusions as a unique and problematic barrier to high-quality end-of-life care in hematologic malignancies. SUMMARY:Recent evidence confirms that hematologic malignancy patients have unique and often unmet palliative care needs, and also have worse end-of-life outcomes. More work is needed to develop and test integrated palliative care interventions in this population.

Authors
LeBlanc, TW; El-Jawahri, A
MLA Citation
LeBlanc, TW, and El-Jawahri, A. "Hemato-oncology and palliative care teams: is it time for an integrated approach to patient care?." Current Opinion in Supportive and Palliative Care 12.4 (December 2018): 530-537.
PMID
30379755
Source
epmc
Published In
Current Opinion in Supportive and Palliative Care
Volume
12
Issue
4
Publish Date
2018
Start Page
530
End Page
537
DOI
10.1097/spc.0000000000000385

Sleep Disturbance Among Individuals with Multiple Myeloma: The Interplay between Physical and Psychosocial Symptoms

Authors
Olson, J; McManus, S; Miller, MF; LeBlanc, TW; Yuen, E; Zaleta, AK; Birhiray, RE; Stein, K
MLA Citation
Olson, J, McManus, S, Miller, MF, LeBlanc, TW, Yuen, E, Zaleta, AK, Birhiray, RE, and Stein, K. "Sleep Disturbance Among Individuals with Multiple Myeloma: The Interplay between Physical and Psychosocial Symptoms." 60th Annual Meeting of the American-Society-of-Hematology (ASH). December 1, 2018 - December 4, 2018. San Diego, CA.: AMER SOC HEMATOLOGY, November 29, 2018.
Source
wos
Published In
Blood
Volume
132
Publish Date
2018
DOI
10.1182/blood-2018-99-113397

Treatment Decision Making and Treatment Satisfaction Among Individuals Living with Chronic Myeloid Leukemia

Authors
Olson, J; McManus, S; Miller, MF; LeBlanc, TW; Yuen, E; Zaleta, AK; Birhiray, RE; Stein, K
MLA Citation
Olson, J, McManus, S, Miller, MF, LeBlanc, TW, Yuen, E, Zaleta, AK, Birhiray, RE, and Stein, K. "Treatment Decision Making and Treatment Satisfaction Among Individuals Living with Chronic Myeloid Leukemia." 60th Annual Meeting of the American-Society-of-Hematology (ASH). December 1, 2018 - December 4, 2018. San Diego, CA.: AMER SOC HEMATOLOGY, November 29, 2018.
Source
wos
Published In
Blood
Volume
132
Publish Date
2018
DOI
10.1182/blood-2018-99-116916

Management of cancer pain

Authors
Leblanc, TW; Kamal, AH
MLA Citation
Leblanc, TW, and Kamal, AH. "Management of cancer pain." DeVita, Hellman, and Rosenberg's Cancer: Principles & Practice of Oncology. November 16, 2018. 2190-2212.
Source
scopus
Publish Date
2018
Start Page
2190
End Page
2212

Assessing the Impact of a Novel Integrated Palliative Care and Medical Oncology Inpatient Service on Health Care Utilization before Hospice Enrollment.

BACKGROUND:Evidence increasingly supports the integration of specialist palliative care (PC) into routine cancer care. A novel, fully integrated PC and medical oncology inpatient service was developed at Duke University Hospital in 2011. OBJECTIVE:To assess the impact of PC integration on health care utilization among hospitalized cancer patients before hospice enrollment. METHODS:Retrospective cohort study. Patients in the solid tumor inpatient unit who were discharged to hospice between September 1, 2009, and June 30, 2010 (pre-PC integration), and September 1, 2011, to June 30, 2012 (postintegration). Cohorts were compared on the following outcomes from their final hospitalization before hospice enrollment: intensive care unit days, invasive procedures, subspecialty consultations, radiographic studies, hospital length of stay, and use of chemotherapy or radiation. Cohort differences were examined with descriptive statistics and nonparametric tests. RESULTS:Two hundred ninety-six patients were included in the analysis (133 pre-PC integration; 163 post-PC integration). Patient characteristics were similar between cohorts. Health care utilization was relatively low in both groups, although 26% and 24% were receiving chemotherapy at the time of admission or during hospitalization in the pre- and post-PC integration cohorts, respectively, and 6.8% in each cohort spent time in an intensive care unit. We found no significant differences in utilization between cohorts. DISCUSSION:PC integration into an inpatient solid tumor service may not impact health care utilization during the final hospitalization before discharge to hospice. This likely reflects the greater benefits of integrating PC farther upstream from the terminal hospitalization, if one hopes to meaningfully impact utilization near the end of life.

Authors
Ray, EM; Riedel, RF; LeBlanc, TW; Rushing, CN; Galanos, AN
MLA Citation
Ray, EM, Riedel, RF, LeBlanc, TW, Rushing, CN, and Galanos, AN. "Assessing the Impact of a Novel Integrated Palliative Care and Medical Oncology Inpatient Service on Health Care Utilization before Hospice Enrollment." Journal of Palliative Medicine (November 3, 2018).
PMID
30394821
Source
epmc
Published In
Journal of Palliative Medicine
Publish Date
2018
DOI
10.1089/jpm.2018.0235

Place of death for patients with cancer in the United States, 1999 through 2015: Racial, age, and geographic disparities.

BACKGROUND:Place of death is an essential component of high quality cancer care and comprehensive national trends and disparities in place of death are unknown. METHODS:Deidentified death certificate data were obtained via the National Center for Health Statistics. All cancer deaths from 1999 through 2015 were included. Multivariate logistic regression was used to test for disparities in place of death associated with sociodemographic variables. RESULTS:From 1999 through 2015, a total of 9,646,498 cancer deaths occurred. Hospital deaths decreased (from 36.6% to 24.6%), whereas the rate of home deaths (38.4% to 42.6%) and hospice facility deaths (0% to 14.0%) both increased (all P<.001). On multivariate logistic regression, all assessed variables were found to be associated with place of death. Specifically, younger age (age birth-14 years: odds ratio [OR], 2.39; age 25-44 years: OR, 1.62), black (OR, 1.83) or Asian (OR, 1.74) race, and Hispanic ethnicity (OR, 1.41) were associated with hospital death. Being married (OR, 2.17) or widowed (OR, 1.56) was associated with home death whereas increasing educational level (OR, 1.15-1.19) was associated with hospice death (all P<.001). Despite overall improvements, certain disparities were found to increase. For young patients, the likelihood of a hospital death increased from 2.3 times to 3.4 times that of older patients (50.9% for those aged 15-24 years vs 15.0% for those aged ≥85 years in 2015). For black patients, the likelihood of a hospital death increased from 1.29 times to 1.42 times that of white patients (32.8% for black patients vs 23.1% for white patients in 2015). CONCLUSIONS:Hospital cancer deaths decreased by approximately one-third with commensurate increases in home and hospice facility deaths. Many sociodemographic groups experience significant disparities with regard to place of death and may benefit from targeted efforts to improve goal-concordant care.

Authors
Chino, F; Kamal, AH; Leblanc, TW; Zafar, SY; Suneja, G; Chino, JP
MLA Citation
Chino, F, Kamal, AH, Leblanc, TW, Zafar, SY, Suneja, G, and Chino, JP. "Place of death for patients with cancer in the United States, 1999 through 2015: Racial, age, and geographic disparities." Cancer 124.22 (November 2018): 4408-4419.
PMID
30343501
Source
epmc
Published In
Cancer
Volume
124
Issue
22
Publish Date
2018
Start Page
4408
End Page
4419
DOI
10.1002/cncr.31737

Patient-reported distress in Hodgkin lymphoma across the survivorship continuum.

PURPOSE:Hodgkin lymphoma (HL) survivors face long-term, elevated risk of treatment-related sequelae, including psychosocial distress associated with poor health outcomes. The magnitude and sources of distress are not well described in the routine care of HL outside of clinical trials. METHODS:We conducted a retrospective cohort study of patients visiting a tertiary-care center for treatment or long-term follow-up of HL. Patient-reported distress was documented using the National Comprehensive Cancer Network Distress Thermometer (DT) and Problem List. Three survivor groups were compared using descriptive methods: on treatment, surviving < 5 years, and surviving ≥ 5 years since diagnosis. RESULTS:A total of 1524 DT were abstracted for 304 patients (106 on treatment, 77 surviving < 5 years, and 121 surviving ≥ 5 years). Distress was low overall (median DT = 1, inter-quartile range 0-4) and was similar across survivor groups. However, actionable distress (score ≥ 4) was reported at 29.5% of clinical encounters. Patients on treatment more frequently reported actionable distress (32.5% of visits) compared with patients surviving < 5 years (20.4%) and ≥ 5 years (28.7%) (P = 0.065). Distress was associated primarily with physical and emotional problems, especially fatigue, worry, and sleep. We did not observe any associations between distress and clinical prognostic factors. CONCLUSIONS:Distress burden is low in HL, but survivorship is marked by periods of actionable distress, largely related to physical symptoms and emotional issues. This burden may be higher when on treatment and is unrelated to disease-related prognostic factors. Survivorship research typically focuses on the post-therapy period, but our results support testing the efficacy of interventions to address distress in HL during active treatment as well.

Authors
Troy, JD; Locke, SC; Samsa, GP; Feliciano, J; Richhariya, A; LeBlanc, TW
MLA Citation
Troy, JD, Locke, SC, Samsa, GP, Feliciano, J, Richhariya, A, and LeBlanc, TW. "Patient-reported distress in Hodgkin lymphoma across the survivorship continuum." Supportive Care in Cancer : Official Journal of the Multinational Association of Supportive Care in Cancer (October 30, 2018).
PMID
30377801
Source
epmc
Published In
Supportive Care in Cancer : Official Journal of the Multinational Association of Supportive Care in Cancer
Publish Date
2018
DOI
10.1007/s00520-018-4523-4

Actigraphy assessment of sleep quality among patients with acute myeloid leukaemia during induction chemotherapy.

Patients receiving induction chemotherapy for acute myeloid leukaemia (AML) anecdotally describe poor sleep, but sleep disturbances have not been well-characterised in this population. We aimed to test the feasibility of measuring sleep quality in AML inpatients using a wearable actigraphy device.Using the Actigraph GT3X 'watch', we assessed the total sleep time, sleep onset latency, wake after sleep onset, number of awakenings after sleep onset and sleep efficiency for inpatients with AML receiving induction chemotherapy. We assessed patient self-reported sleep quality using the Pittsburgh Sleep Quality Index (PSQI).Of the 12 patients enrolled, 11 completed all actigraphy and PSQI assessments, demonstrating feasibility. Patients wore the Actigraph device for a mean (SD) of 15.92 (8.3) days, and actigraphy measures suggested poor sleep. Patients had a median average awakening length of 6.92 min, a median number of awakenings after sleep onset of 4 and a median sleep onset latency of 10.8 min. Actual median sleep efficiency (0.91) was high, suggesting that patients' poor sleep was not due to insomnia but perhaps due to interruptions, such as administration of medications, lab draws and vital sign measurements.Collection of sleep quality data among inpatients with AML via a wearable actigraphy device is feasible. AML inpatients appear to have poor sleep quality and quantity, suggesting that sleep issues represent an area of unmet supportive care needs in AML. Further research in this areas is needed to inform the development of interventions to improve sleep duration and quality in hospitalised patients with AML.

Authors
Yang, C-FJ; Aibel, K; Meyerhoff, R; Wang, F; Harpole, D; Abernethy, AP; LeBlanc, TW
MLA Citation
Yang, C-FJ, Aibel, K, Meyerhoff, R, Wang, F, Harpole, D, Abernethy, AP, and LeBlanc, TW. "Actigraphy assessment of sleep quality among patients with acute myeloid leukaemia during induction chemotherapy." Bmj Supportive & Palliative Care 8.3 (September 2018): 274-277.
PMID
29643104
Source
epmc
Published In
Bmj Supportive & Palliative Care
Volume
8
Issue
3
Publish Date
2018
Start Page
274
End Page
277
DOI
10.1136/bmjspcare-2018-001509

Palliative Performance Scale Score at 1 Week After Palliative Care Unit Admission is More Useful for Survival Prediction in Patients With Advanced Cancer in South Korea.

BACKGROUND:The Palliative Performance Scale (PPS) is a useful prognostic index in palliative care. Changes in PPS score over time may add useful prognostic information beyond a single measurement. OBJECTIVE:To investigate the usefulness of repeated PPS measurement to predict survival time of inpatients with advanced cancer admitted to a palliative care unit (PCU) in South Korea. DESIGN:Prospective observational cohort study. SETTING/PATIENTS:138 patients with advanced cancer admitted to a PCU in a university hospital in South Korea from June 2015 to May 2016. MEASUREMENTS:The PPS score was measured on enrollment and after 1 week. We used Cox regression analyses to calculate hazard ratios (HRs) to demonstrate the relationship between survival time and the groups categorized by PPS and changes in PPS score, after adjusting for clinical variables. RESULTS:There were significant differences in survival time among 3 groups stratified by PPS (10-20, 30-50, and ≥60) after 1 week. A group with a PPS of 10 to 20 at 1 week had the highest risk (HR: 5.18 [95% confidence interval, 1.57-17.04]) for shortened survival. On the contrary, there were no significant differences among these groups by initial PPS alone. Similarly, change in PPS was prognostic; median survival was 13 (10.96-15.04) days for those whose PPS decreased after 1 week and 27 (10.18-43.82) days for those with stable or increased PPS ( P < .001). CONCLUSIONS:Measuring PPS over time can be very helpful for predicting survival in terminally ill patients with cancer, beyond a single PPS measure at PCU admission.

Authors
Yoon, S-J; Choi, S-E; LeBlanc, TW; Suh, S-Y
MLA Citation
Yoon, S-J, Choi, S-E, LeBlanc, TW, and Suh, S-Y. "Palliative Performance Scale Score at 1 Week After Palliative Care Unit Admission is More Useful for Survival Prediction in Patients With Advanced Cancer in South Korea." The American Journal of Hospice & Palliative Care 35.9 (September 2018): 1168-1173.
PMID
29660991
Source
epmc
Published In
The American Journal of Hospice & Palliative Care
Volume
35
Issue
9
Publish Date
2018
Start Page
1168
End Page
1173
DOI
10.1177/1049909118770604

Palliative care integration in haematological malignancies: towards a needs-based approach.

Authors
Strand, JJ; LeBlanc, TW
MLA Citation
Strand, JJ, and LeBlanc, TW. "Palliative care integration in haematological malignancies: towards a needs-based approach." Bmj Supportive & Palliative Care 8.3 (September 2018): 289-291.
PMID
30115620
Source
epmc
Published In
Bmj Supportive & Palliative Care
Volume
8
Issue
3
Publish Date
2018
Start Page
289
End Page
291
DOI
10.1136/bmjspcare-2018-001611

Evidence-based Management of Cancer Pain.

OBJECTIVE:To provide a brief review of common palliative care practices in the assessment and management of cancer pain for practicing oncology nurses. DATA SOURCES:Published literature as indexed in Medline, relevant guideline documents, textbooks, and clinical experience. CONCLUSION:All persons with cancer should undergo a comprehensive pain assessment, using validated instruments when possible, and receive expert-guided cancer pain therapy. Specialist palliative care consultation should be engaged as needed to provide an extra layer of support. IMPLICATIONS FOR NURSING PRACTICE:By better understanding cancer pain assessment and management strategies, nurses will be best equipped to meet the needs of patients and families.

Authors
Webb, JA; LeBlanc, TW
MLA Citation
Webb, JA, and LeBlanc, TW. "Evidence-based Management of Cancer Pain." Seminars in Oncology Nursing 34.3 (August 10, 2018): 215-226. (Review)
PMID
30100369
Source
epmc
Published In
Seminars in Oncology Nursing
Volume
34
Issue
3
Publish Date
2018
Start Page
215
End Page
226
DOI
10.1016/j.soncn.2018.06.003

Transfusion dependence, use of hospice services, and quality of end-of-life care in leukemia.

Hospice provides high-quality end-of-life care, but patients with leukemias use hospice services less frequently than those with solid tumors. Transfusion dependence (TD) may hinder or delay enrollment, because hospice organizations typically disallow transfusions. We examined the association between TD and end-of-life outcomes among Medicare beneficiaries with leukemia. From the Surveillance, Epidemiology, and End Results-Medicare database, we selected beneficiaries with acute and chronic leukemias who died in 2001-2011. We defined TD as ≥2 transfusions within 30 days before death or hospice enrollment. End points included hospice enrollment and length of stay, reporting relative risk (RR) adjusted for key covariates. Among 21 033 patients with a median age of 79 years, 20% were transfusion dependent before death/hospice enrollment. Use of hospice increased from 35% in 2001 to 49% in 2011. Median time on hospice was 9 days and was shorter for transfusion-dependent patients (6 vs 11 days; P < .001). Adjusting for baseline characteristics, TD was associated with a higher use of hospice services (RR, 1.08; 95% confidence interval [CI], 1.04-1.12) but also with 51% shorter hospice length of stay (RR, 0.49; 95% CI, 0.44-0.54). Hospice enrollees had a lower likelihood of inpatient death and chemotherapy use and lower median Medicare spending at end-of-life, regardless of TD status. In conclusion, relatively increased hospice use combined with a markedly shorter length of stay among transfusion-dependent patients suggests that they have a high and incompletely met need for hospice services and that they experience a barrier to timely referral. Policy solutions supporting palliative transfusions may maximize the benefits of hospice for leukemia patients.

Authors
LeBlanc, TW; Egan, PC; Olszewski, AJ
MLA Citation
LeBlanc, TW, Egan, PC, and Olszewski, AJ. "Transfusion dependence, use of hospice services, and quality of end-of-life care in leukemia." Blood 132.7 (August 2018): 717-726.
PMID
29848484
Source
epmc
Published In
Blood
Volume
132
Issue
7
Publish Date
2018
Start Page
717
End Page
726
DOI
10.1182/blood-2018-03-842575

The Surprise Question and Identification of Palliative Care Needs among Hospitalized Patients with Advanced Hematologic or Solid Malignancies.

Little is known about quality of life (QOL), depression, and end-of-life (EOL) outcomes among hospitalized patients with advanced cancer.To assess whether the surprise question identifies inpatients with advanced cancer likely to have unmet palliative care needs.Prospective cohort study and long-term follow-up.From 2008 to 2010, we enrolled 150 inpatients at Duke University with stage III/IV solid tumors or lymphoma/acute leukemia and whose physician would not be surprised if they died in less than one year.We assessed QOL (FACT-G), mood (brief CES-D), and EOL outcomes.Mean FACT-G score was quite low (66.9; SD 11). Forty-five patients (30%) had a brief CES-D score of ≥4 indicating a high likelihood of depression. In multivariate analyses, better QOL was associated with less depression (OR 0.91, p < 0.0001), controlling for tumor type, education, and spiritual well-being. Physicians correctly estimated death within one year in 101 (69%) cases, yet only 37 patients (25%) used hospice, and 4 (2.7%) received a palliative care consult; 89 (60.5%) had a do-not-resuscitate order, and 63 (43%) died in the hospital.The surprise question identifies inpatients with advanced solid or hematologic cancers having poor QOL and frequent depressive symptoms. Although physicians expected death within a year, EOL quality outcomes were poor. Hospitalized patients with advanced cancer may benefit from palliative care interventions to improve mood, QOL, and EOL care, and the surprise question is a practical method to identify those with unmet needs.

Authors
Hudson, KE; Wolf, SP; Samsa, GP; Kamal, AH; Abernethy, AP; LeBlanc, TW
MLA Citation
Hudson, KE, Wolf, SP, Samsa, GP, Kamal, AH, Abernethy, AP, and LeBlanc, TW. "The Surprise Question and Identification of Palliative Care Needs among Hospitalized Patients with Advanced Hematologic or Solid Malignancies." Journal of Palliative Medicine 21.6 (June 2018): 789-795.
PMID
29420142
Source
epmc
Published In
Journal of Palliative Medicine
Volume
21
Issue
6
Publish Date
2018
Start Page
789
End Page
795
DOI
10.1089/jpm.2017.0509

Information Framing Reduces Initial Negative Attitudes in Cancer Patients' Decisions About Hospice Care.

Negative attitudes toward hospice care might prevent patients with cancer from discussing and choosing hospice as they approach end of life. When making a decision, people often naturally focus on either expected benefits or the avoidance of harm. Behavioral research has demonstrated that framing information in an incongruent manner with patients' underlying motivational focus reduces their negative attitudes toward a disliked option.Our study tests this communication technique with cancer patients, aiming to reduce negative attitudes toward a potentially beneficial but often-disliked option, that is, hospice care.Patients (n = 42) with active cancer of different types and/or stages completed a paper survey. Participants read a vignette about a patient with advanced cancer and a limited prognosis. In the vignette, the physician's advice to enroll in a hospice program was randomized, creating a congruent message or an incongruent message with patients' underlying motivational focus (e.g., a congruent message for someone most interested in benefits focuses on the benefits of hospice, whereas an incongruent message for this patient focuses on avoiding harm). Patients' attitudes toward hospice were measured before and after receiving the physician's advice.Regression analyses indicated that information framing significantly influenced patients with strong initial negative attitudes. Patients were more likely to reduce intensity of their initial negative attitude about hospice when receiving an incongruent message (b = -0.23; P < 0.01) than a congruent one (b = -0.13; P = 0.08).This finding suggests a new theory-driven approach to conversations with cancer patients who may harbor negative reactions toward hospice care.

Authors
Fridman, I; Glare, PA; Stabler, SM; Epstein, AS; Wiesenthal, A; Leblanc, TW; Higgins, ET
MLA Citation
Fridman, I, Glare, PA, Stabler, SM, Epstein, AS, Wiesenthal, A, Leblanc, TW, and Higgins, ET. "Information Framing Reduces Initial Negative Attitudes in Cancer Patients' Decisions About Hospice Care." Journal of Pain and Symptom Management 55.6 (June 2018): 1540-1545.
PMID
29474940
Source
epmc
Published In
Journal of Pain and Symptom Management
Volume
55
Issue
6
Publish Date
2018
Start Page
1540
End Page
1545
DOI
10.1016/j.jpainsymman.2018.02.010

Pain Syndromes and Management in Adult Hematopoietic Stem Cell Transplantation.

Pain is a significant physical symptom that can be observed across the spectrum of hematopoietic stem cell transplant (HSCT) care. Pain assessment should include evaluation of the physical and functional components of pain. Management varies based on the type of HSCT-specific pain syndrome. Future directions for management of pain syndromes include the early integration of palliative care. The purpose of this review is to summarize various pain syndromes and management approaches in adult HSCT patients.

Authors
Ma, JD; El-Jawahri, AR; LeBlanc, TW; Roeland, EJ
MLA Citation
Ma, JD, El-Jawahri, AR, LeBlanc, TW, and Roeland, EJ. "Pain Syndromes and Management in Adult Hematopoietic Stem Cell Transplantation." Hematology/Oncology Clinics of North America 32.3 (June 2018): 551-567. (Review)
PMID
29729788
Source
epmc
Published In
Hematology/Oncology Clinics of North America
Volume
32
Issue
3
Publish Date
2018
Start Page
551
End Page
567
DOI
10.1016/j.hoc.2018.01.012

Development of a digital patient navigation application: Results from subject interviews.

Authors
LeBlanc, TW; Herring, K; Chilcott, J; Bletcher, K; Osaki, M; Manassei, H; Pendergraft, T; Corbett, C; Zafar, Y; Higgins, A; Patierno, SR
MLA Citation
LeBlanc, TW, Herring, K, Chilcott, J, Bletcher, K, Osaki, M, Manassei, H, Pendergraft, T, Corbett, C, Zafar, Y, Higgins, A, and Patierno, SR. "Development of a digital patient navigation application: Results from subject interviews.": American Society of Clinical Oncology (ASCO), May 20, 2018.
Source
crossref
Published In
Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology
Volume
36
Issue
15_suppl
Publish Date
2018
Start Page
e22146
End Page
e22146
DOI
10.1200/jco.2018.36.15_suppl.e22146

Patient-clinician communication about nutrition, weight, fitness, and fatigue in cancer care.

Authors
Zaleta, AK; McManus, S; Olson, JS; LeBlanc, TW; Hamilton, K; Koesel, N
MLA Citation
Zaleta, AK, McManus, S, Olson, JS, LeBlanc, TW, Hamilton, K, and Koesel, N. "Patient-clinician communication about nutrition, weight, fitness, and fatigue in cancer care.": AMER SOC CLINICAL ONCOLOGY, May 20, 2018.
Source
wos
Published In
Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology
Volume
36
Issue
15
Publish Date
2018
DOI
10.1200/JCO.2018.36.15_suppl.e22131

Psychological distress in myelodysplastic syndromes.

Authors
Vallely, J; Troy, JD; Locke, SC; LeBlanc, TW
MLA Citation
Vallely, J, Troy, JD, Locke, SC, and LeBlanc, TW. "Psychological distress in myelodysplastic syndromes.": AMER SOC CLINICAL ONCOLOGY, May 20, 2018.
Source
wos
Published In
Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology
Volume
36
Issue
15
Publish Date
2018
DOI
10.1200/JCO.2018.36.15_suppl.e19027

Can oral chemotherapy parity laws reduce patients’ out-of-pocket (OOP) costs?

Authors
Sitlinger, AP; Sachdev, R; Ubel, PA; Wong, C; LeBlanc, TW; Zhang, T; Anderson, D; Zafar, Y
MLA Citation
Sitlinger, AP, Sachdev, R, Ubel, PA, Wong, C, LeBlanc, TW, Zhang, T, Anderson, D, and Zafar, Y. "Can oral chemotherapy parity laws reduce patients’ out-of-pocket (OOP) costs?.": American Society of Clinical Oncology (ASCO), May 20, 2018.
Source
crossref
Published In
Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology
Volume
36
Issue
15_suppl
Publish Date
2018
Start Page
6620
End Page
6620
DOI
10.1200/jco.2018.36.15_suppl.6620

Barriers to palliative care (PC) utilization in hematopoietic stem cell transplantation (HCT).

Authors
El-Jawahri, A; LeBlanc, TW; Burns, LJ; Denzen, EM; Meyer, C; Mau, L-W
MLA Citation
El-Jawahri, A, LeBlanc, TW, Burns, LJ, Denzen, EM, Meyer, C, and Mau, L-W. "Barriers to palliative care (PC) utilization in hematopoietic stem cell transplantation (HCT).": AMER SOC CLINICAL ONCOLOGY, May 20, 2018.
Source
wos
Published In
Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology
Volume
36
Issue
15
Publish Date
2018
DOI
10.1200/JCO.2018.36.15_suppl.10116

Comprehensive evaluation of place of death for patients with hematological malignancies, 1999-2015

Authors
Chino, FL; Kamal, A; Chino, JP; LeBlanc, TW
MLA Citation
Chino, FL, Kamal, A, Chino, JP, and LeBlanc, TW. "Comprehensive evaluation of place of death for patients with hematological malignancies, 1999-2015.": AMER SOC CLINICAL ONCOLOGY, May 20, 2018.
Source
wos
Published In
Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology
Volume
36
Issue
15
Publish Date
2018
DOI
10.1200/JCO.2018.36.15_suppl.10024

Hospice use among Medicare fee-for-service (FFS) or managed-care organization (MCO) enrollees with leukemia and myeloma

Authors
Olszewski, AJ; Egan, P; LeBlanc, TW
MLA Citation
Olszewski, AJ, Egan, P, and LeBlanc, TW. "Hospice use among Medicare fee-for-service (FFS) or managed-care organization (MCO) enrollees with leukemia and myeloma.": AMER SOC CLINICAL ONCOLOGY, May 20, 2018.
Source
wos
Published In
Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology
Volume
36
Issue
15
Publish Date
2018
DOI
10.1200/JCO.2018.36.15_suppl.10025

Trends and disparities in place of death for cancer patients in the United States, 1999-2015

Authors
Chino, FL; Kamal, A; LeBlanc, TW; Zafar, Y; Suneja, G; Chino, JP
MLA Citation
Chino, FL, Kamal, A, LeBlanc, TW, Zafar, Y, Suneja, G, and Chino, JP. "Trends and disparities in place of death for cancer patients in the United States, 1999-2015.": AMER SOC CLINICAL ONCOLOGY, May 20, 2018.
Source
wos
Published In
Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology
Volume
36
Issue
15
Publish Date
2018
DOI
10.1200/JCO.2018.36.15_suppl.6522

The impact of remission status on patients' experiences with acute myeloid leukemia (AML): an exploratory analysis of longitudinal patient-reported outcomes data.

PURPOSE:Shared decision-making in acute myeloid leukemia (AML) requires understanding patients' longitudinal experiences of illness, but little is known about the impact of remission status on patient-reported outcomes (PROs). We aimed to explore the association between remission status and PROs 6-12 months following induction chemotherapy. METHODS:Forty-two patients completed three validated instruments characterizing symptom burden (Patient Care Monitor v2.0), distress (NCCN Distress Thermometer), and QOL (FACT-Leu), as part of a longitudinal observational study. We used regression models to explore the relationship between remission status and PROs, and explore differences by initial disease type (de novo versus secondary/relapsed AML). RESULTS:Those with secondary or relapsed AML at study onset had marked impairments in all measures compared to de novo AML patients. After 6 months, their mean distress score was 4.8 (> 4.0 warrants intervention), they reported a mean of 14.1 moderate/severe symptoms and had a mean QOL score of 113.6, compared to 1.0, 1.7, and 155.2, respectively, for those with de novo AML (p < .0001). Similarly, patients in relapse had a mean distress score of 5.3, a mean of 12.8 moderate/severe symptoms, and a mean QOL score of 113.4, compared to 1.8, 5.7, and 143.8, respectively, among those in remission (p < .005). These patterns persisted after adjusting for baseline differences (p < .0001). CONCLUSION:Remission is associated with markedly better patient well-being in AML. Patients with secondary or relapsed AML face more severe symptom burden, distress, and QOL issues after induction. Interventions are needed to improve AML patients' experiences of illness.

Authors
Kayastha, N; Wolf, SP; Locke, SC; Samsa, GP; El-Jawahri, A; LeBlanc, TW
MLA Citation
Kayastha, N, Wolf, SP, Locke, SC, Samsa, GP, El-Jawahri, A, and LeBlanc, TW. "The impact of remission status on patients' experiences with acute myeloid leukemia (AML): an exploratory analysis of longitudinal patient-reported outcomes data." Supportive Care in Cancer : Official Journal of the Multinational Association of Supportive Care in Cancer 26.5 (May 2018): 1437-1445.
PMID
29151174
Source
epmc
Published In
Supportive Care in Cancer : Official Journal of the Multinational Association of Supportive Care in Cancer
Volume
26
Issue
5
Publish Date
2018
Start Page
1437
End Page
1445
DOI
10.1007/s00520-017-3973-4

A Cohort Study of Patient-Reported Outcomes and Healthcare Utilization in Acute Myeloid Leukemia Patients Receiving Active Cancer Therapy in the Last Six Months of Life.

Evidence about the unique palliative care needs of patients with acute myeloid leukemia (AML) is limited. Improving the care of these patients will require a better understanding of their unmet needs, including symptom burden at the end of life, and patterns of healthcare utilization.To describe AML patients' experiences in the last six months of life regarding symptom burden, blood product utilization, and use of palliative care services.Exploratory analysis of prospectively collected patient-reported outcomes and healthcare utilization data during the last six months of life among 33 AML patients who died during a longitudinal observational study.Symptom burden, quality of life (QOL), and psychological distress worsened with proximity to death. Of the 26 patients with utilization data, most (n = 24; 92.4%) were hospitalized in the last month of life, with 26.9% (n = 7) dying in the intensive care unit. Patients required a median of 16 red blood cell transfusions in the last six months of life, and those with a high transfusion burden in the last month of life had a higher rate of in-hospital death (blood transfusions: p < 0.01; platelet transfusions: p = 0.03). Only six patients enrolled in hospice (23.1%).Patients with AML have marked symptoms and QOL impairments that escalate in the final six months of life. Patients entering the healthcare system for active cancer treatment are likely to continue disease-oriented care until death. High rates of hospitalization and blood product transfusion are a direct barrier to transitioning to hospice care.

Authors
Lowe, JR; Yu, Y; Wolf, S; Samsa, G; LeBlanc, TW
MLA Citation
Lowe, JR, Yu, Y, Wolf, S, Samsa, G, and LeBlanc, TW. "A Cohort Study of Patient-Reported Outcomes and Healthcare Utilization in Acute Myeloid Leukemia Patients Receiving Active Cancer Therapy in the Last Six Months of Life." Journal of Palliative Medicine 21.5 (May 2018): 592-597.
PMID
29341836
Source
epmc
Published In
Journal of Palliative Medicine
Volume
21
Issue
5
Publish Date
2018
Start Page
592
End Page
597
DOI
10.1089/jpm.2017.0463

Top Ten Tips for Palliative Care Clinicians Caring for Cancer Patients Receiving Immunotherapies.

Patients with cancer face an ever-changing landscape of tumor-directed therapies available to improve quality of life and potentially increase survival. The most recent advances, immunotherapeutics, offer a novel way to target cancer cells by engaging the body's own immune system. Using an expert panel of oncologists, palliative medicine physicians, and dual-trained specialists, we discuss current immunotherapies and their clinical uses, potential side effects and management strategies, and the implications of these newer treatments on goals of care conversations and care coordination. We aim to further engage palliative care specialists in the active care of cancer patients receiving immunotherapeutics and use a "Top 10" tips format to concisely present practical learning points to busy clinicians.

Authors
Wiesenthal, AC; Patel, SP; LeBlanc, TW; Roeland, EJ; Kamal, AH
MLA Citation
Wiesenthal, AC, Patel, SP, LeBlanc, TW, Roeland, EJ, and Kamal, AH. "Top Ten Tips for Palliative Care Clinicians Caring for Cancer Patients Receiving Immunotherapies." Journal of Palliative Medicine 21.5 (May 2018): 694-699.
PMID
29658821
Source
epmc
Published In
Journal of Palliative Medicine
Volume
21
Issue
5
Publish Date
2018
Start Page
694
End Page
699
DOI
10.1089/jpm.2018.0107

It is time to rethink weight loss in cancer.

Authors
Currow, DC; LeBlanc, TW
MLA Citation
Currow, DC, and LeBlanc, TW. "It is time to rethink weight loss in cancer." Annals of Oncology : Official Journal of the European Society for Medical Oncology 29.5 (May 2018): 1090-1091.
PMID
29788171
Source
epmc
Published In
Annals of Oncology
Volume
29
Issue
5
Publish Date
2018
Start Page
1090
End Page
1091
DOI
10.1093/annonc/mdy112

"How Much Time Do I Have?": Communicating Prognosis in the Era of Exceptional Responders.

Prognostication is the science by which clinicians estimate a patient's expected outcome. A robust literature shows that many patients with advanced cancer have inaccurate perceptions of their prognosis, thus raising questions about whether patients are truly making informed decisions. Clinicians' ability to communicate prognostic information is further complicated today by the availability of novel, efficacious immunotherapies and genome-guided treatments. Currently, clinicians lack tools to predict which patients with advanced disease will achieve an exceptional response to these new therapies. This increased prognostic uncertainty on the part of clinicians further complicates prognostic communication with patients. Evidence also suggests that many oncologists avoid or rarely engage in prognosis-related communication and/or lack skills in this area. Although communication skills training interventions can have a positive impact on complex communication skills for some clinicians, there is no one-size-fits-all approach to improving patient-clinician communication about prognosis. Yet improving patient understanding of prognosis is critical, because patient understanding of prognosis is linked with end-of-life care outcomes. Solutions to this problem will likely require a combination of interventions beyond communication skills training programs, including enhanced use of other cancer clinicians, such as oncology nurses and social workers, increased use of palliative care specialists, and organizational support to facilitate advance care planning.

Authors
LeBlanc, TW; Temel, JS; Helft, PR
MLA Citation
LeBlanc, TW, Temel, JS, and Helft, PR. ""How Much Time Do I Have?": Communicating Prognosis in the Era of Exceptional Responders." American Society of Clinical Oncology Educational Book. American Society of Clinical Oncology. Annual Meeting 38 (May 2018): 787-794. (Review)
PMID
30231384
Source
epmc
Published In
American Society of Clinical Oncology Educational Book. American Society of Clinical Oncology. Meeting
Issue
38
Publish Date
2018
Start Page
787
End Page
794
DOI
10.1200/edbk_201211

HOLDING BACK ASSOCIATED WITH CAREGIVER STRAIN AND DISTRESS AMONG CAREGIVERS OF PATIENTS WITH ADVANCED CANCER AND PAIN

Authors
Puleo, B; Keefe, F; Bull, J; Hanson, L; Fischer, S; Leblanc, T; Steele, J; Porter, L
MLA Citation
Puleo, B, Keefe, F, Bull, J, Hanson, L, Fischer, S, Leblanc, T, Steele, J, and Porter, L. "HOLDING BACK ASSOCIATED WITH CAREGIVER STRAIN AND DISTRESS AMONG CAREGIVERS OF PATIENTS WITH ADVANCED CANCER AND PAIN.": OXFORD UNIV PRESS INC, April 1, 2018.
Source
wos
Published In
Annals of Behavioral Medicine
Volume
52
Publish Date
2018
Start Page
S498
End Page
S498

Triadic treatment decision-making in advanced cancer: a pilot study of the roles and perceptions of patients, caregivers, and oncologists.

PURPOSE:The research on cancer treatment decision-making focuses on dyads; the full "triad" of patients, oncologists, and caregivers remains largely unstudied. We investigated how all members of this triad perceive and experience decisions related to treatment for advanced cancer. METHODS:At an academic cancer center, we enrolled adult patients with advanced gastrointestinal or hematological malignancies, their caregivers, and their oncologists. Triad members completed a semi-structured qualitative interview and a survey measuring decisional conflict and perceived influence of the other triad members on treatment decisions. RESULTS:Seventeen patients, 14 caregivers, and 10 oncologists completed the study. Patients and caregivers reported little decisional regret and voiced high satisfaction with their decisions, but levels of decisional conflict were high. We found sizeable disagreement among triad members' perceptions and preferences. For example, patients and oncologists disagreed about the caregiver's influence on the decision 56% of the time. In addition, many patients and caregivers preferred to defer to their oncologist about treatment decisions, felt like no true decision existed, and disagreed with their oncologist about how many treatment options had been presented. CONCLUSIONS:Patients, caregivers, and oncologists have discordant perceptions of the cancer treatment decision-making process, and bring different preferences about how they want to make decisions. These data suggest that oncologists should assess patients' and caregivers' decisional preferences, explicitly signal that a decision needs to be made whenever approaching an important crossroads in treatment and ensure that patients and caregivers understand the full range of presented options.

Authors
LeBlanc, TW; Bloom, N; Wolf, SP; Lowman, SG; Pollak, KI; Steinhauser, KE; Ariely, D; Tulsky, JA
MLA Citation
LeBlanc, TW, Bloom, N, Wolf, SP, Lowman, SG, Pollak, KI, Steinhauser, KE, Ariely, D, and Tulsky, JA. "Triadic treatment decision-making in advanced cancer: a pilot study of the roles and perceptions of patients, caregivers, and oncologists." Supportive Care in Cancer : Official Journal of the Multinational Association of Supportive Care in Cancer 26.4 (April 2018): 1197-1205.
PMID
29101469
Source
epmc
Published In
Supportive Care in Cancer : Official Journal of the Multinational Association of Supportive Care in Cancer
Volume
26
Issue
4
Publish Date
2018
Start Page
1197
End Page
1205
DOI
10.1007/s00520-017-3942-y

Open Oncology Notes: A Qualitative Study of Oncology Patients' Experiences Reading Their Cancer Care Notes.

PURPOSE:Electronic medical records increasingly allow patients access to clinician notes. Although most believe that open notes benefits patients, some suggest negative consequences. Little is known about the experiences of patients with cancer reading their medical notes; thus we aimed to describe this qualitatively. METHODS:We interviewed 20 adults with metastatic or incurable cancer receiving cancer treatment. The semistructured qualitative interviews included four segments: assessing their overall experience reading notes, discussing how notes affected their cancer care experiences, reading a real note with the interviewer, and making suggestions for improvement. We used a constant comparison approach to analyze these qualitative data. RESULTS:We found four themes. Patients reported that notes resulted in the following: (1) increased comprehension; (2) ameliorated uncertainty, relieved anxiety, and facilitated control; (3) increased trust; and (4) for a subset of patients, increased anxiety. Patients described increased comprehension because notes refreshed their memory and clarified their understanding of visits. This helped mitigate the unfamiliarity of cancer, addressing uncertainty and relieving anxiety. Notes facilitated control, empowering patients to ask clinicians more questions. The transparency of notes also increased trust in clinicians. For a subset of patients, however, notes were emotionally difficult to read and raised concerns. Patients identified medical jargon and repetition in notes as areas for improvement. CONCLUSION:Most patients thought that reading notes improved their care experiences. A small subset of patients experienced increased distress. As reading notes becomes a routine part of the patient experience, physicians might want to elicit and address concerns that arise from notes, thereby further engaging patients in their care.

Authors
Kayastha, N; Pollak, KI; LeBlanc, TW
MLA Citation
Kayastha, N, Pollak, KI, and LeBlanc, TW. "Open Oncology Notes: A Qualitative Study of Oncology Patients' Experiences Reading Their Cancer Care Notes." Journal of Oncology Practice 14.4 (April 2018): e251-e258.
PMID
29443650
Source
epmc
Published In
J Oncol Pract
Volume
14
Issue
4
Publish Date
2018
Start Page
e251
End Page
e258
DOI
10.1200/jop.2017.028605

A National Survey Study of Transplant Physicians' Attitudes About Palliative Care

Authors
EI-Jawahri, AR; LeBlanc, TW; Burns, LJ; Denzen, EM; Meyer, C; Mau, L-W; Roeland, E; Wood, WA; Petersdorf, EW
MLA Citation
EI-Jawahri, AR, LeBlanc, TW, Burns, LJ, Denzen, EM, Meyer, C, Mau, L-W, Roeland, E, Wood, WA, and Petersdorf, EW. "A National Survey Study of Transplant Physicians' Attitudes About Palliative Care." Blood and Marrow Transplantion Tandem Meetings of the Center-for-International-Blood-and-Marrow-Transplant-Research (CIBMTR) / American-Society-for-Blood-and-Marrow-Transplantation (ASBMT). February 21, 2018 - February 25, 2018. Salt Lake City, UT.: ELSEVIER SCIENCE INC, March 1, 2018.
Source
wos
Published In
Biology of Blood and Marrow Transplantation : Journal of the American Society for Blood and Marrow Transplantation
Volume
24
Issue
3
Publish Date
2018
Start Page
S42
End Page
S43

Patient-Reported Distress in Myelodysplastic Syndromes and Its Association With Clinical Outcomes: A Retrospective Cohort Study.

Background: NCCN defines distress as a multifactorial, unpleasant emotional experience of a psychological nature that may interfere with patients' ability to cope with cancer symptoms and treatment. Patients with myelodysplastic syndromes (MDS) are at risk for distress due to the largely incurable nature of this hematopoietic malignancy and its symptom burden, yet associations with clinical outcomes are unknown. Methods: We retrospectively reviewed patient-reported distress data from adult ambulatory patients with MDS visiting a single, tertiary care medical center from July 2013 to September 2015. Demographic, diagnostic, treatment, and comorbidity information were abstracted from records along with NCCN Distress Thermometer (DT) and Problem List (PL) scores. Survival was analyzed using the Kaplan-Meier method and Cox proportional hazards regression. Results: We abstracted 376 DT scores (median, 1; range, 0-10) from 606 visits and 110 patients (median, 2 DT scores/patient; range, 1-16). NCCN Guidelines suggest that patients with DT scores ≥4 should be evaluated for referral to specialty services to address unmet needs. A total of 54 patients (49%) had at least 1 DT score ≥4 and 20 (18%) had 2 or more DT scores ≥4; 98 patients (89.1%) reported 1,379 problems during 23,613 person-days of follow-up (median, 4 problems/patient/visit; range, 1-23). The 5 most frequently reported problems were fatigue (181 times; 78 patients), pain (95 times; 46 patients), worry (80 times; 45 patients), sleep (78 times; 41 patients), and tingling hands/feet (68 times; 33 patients). After adjustment for risk stratification at diagnosis, a single point increase on the DT was associated with an increased risk of death (hazard ratio, 1.18; 95% CI, 1.01-1.36). Conclusions: Patients with MDS experience a high burden of distress, and patient-reported distress is associated with clinical outcomes. Distress should be further studied as a prognostic variable and a marker of unmet needs in MDS.

Authors
Troy, JD; de Castro, CM; Pupa, MR; Samsa, GP; Abernethy, AP; LeBlanc, TW
MLA Citation
Troy, JD, de Castro, CM, Pupa, MR, Samsa, GP, Abernethy, AP, and LeBlanc, TW. "Patient-Reported Distress in Myelodysplastic Syndromes and Its Association With Clinical Outcomes: A Retrospective Cohort Study." Journal of the National Comprehensive Cancer Network : JNCCN 16.3 (March 2018): 267-273.
PMID
29523665
Source
epmc
Published In
Jnccn Journal of the National Comprehensive Cancer Network
Volume
16
Issue
3
Publish Date
2018
Start Page
267
End Page
273
DOI
10.6004/jnccn.2017.7048

Development of a digital patient navigation application: Preliminary results from patient interviews.

Authors
LeBlanc, TW; Herring, K; Chilcott, J; Bletcher, K; Osaka, M; Manassei, H; Pendergraft, T; Corbett, C; Zafar, Y; Higgins, A; Patierno, SR
MLA Citation
LeBlanc, TW, Herring, K, Chilcott, J, Bletcher, K, Osaka, M, Manassei, H, Pendergraft, T, Corbett, C, Zafar, Y, Higgins, A, and Patierno, SR. "Development of a digital patient navigation application: Preliminary results from patient interviews.": American Society of Clinical Oncology (ASCO), March 2018.
Source
crossref
Published In
Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology
Volume
36
Issue
7_suppl
Publish Date
2018
Start Page
161
End Page
161
DOI
10.1200/jco.2018.36.7_suppl.161

Perceptions of unintentional weight loss among cancer survivors.

Authors
Zaleta, AK; McManus, S; LeBlanc, TW; Buzaglo, JS
MLA Citation
Zaleta, AK, McManus, S, LeBlanc, TW, and Buzaglo, JS. "Perceptions of unintentional weight loss among cancer survivors.": American Society of Clinical Oncology (ASCO), March 2018.
Source
crossref
Published In
Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology
Volume
36
Issue
7_suppl
Publish Date
2018
Start Page
138
End Page
138
DOI
10.1200/jco.2018.36.7_suppl.138

Oncologist in My Pocket: What the Hospice & Palliative Clinician Needs to Know About Hematology/Oncology

Authors
Newport, K; Sivendran, S; LeBlanc, T; Kim, S; Jones, J
MLA Citation
Newport, K, Sivendran, S, LeBlanc, T, Kim, S, and Jones, J. "Oncologist in My Pocket: What the Hospice & Palliative Clinician Needs to Know About Hematology/Oncology." Annual Assembly of the American-Academy-of-Hospice-and-Palliative-Medicine and the Hospice-and-Palliative-Nurses-Association. March 14, 2018 - March 17, 2018. Boston, MA.: ELSEVIER SCIENCE INC, February 1, 2018.
Source
wos
Published In
Journal of Pain and Symptom Management
Volume
55
Issue
2
Publish Date
2018
Start Page
557
End Page
557

High levels of holding back associated with higher caregiver strain and psychological distress among caregivers of patients with advanced cancer and pain

Authors
Puleo, B; Keefe, F; Bull, J; Hanson, L; Fischer, S; LeBlanc, T; Steel, J; Porter, L
MLA Citation
Puleo, B, Keefe, F, Bull, J, Hanson, L, Fischer, S, LeBlanc, T, Steel, J, and Porter, L. "High levels of holding back associated with higher caregiver strain and psychological distress among caregivers of patients with advanced cancer and pain.": WILEY, February 1, 2018.
Source
wos
Published In
Psycho Oncology
Volume
27
Publish Date
2018
Start Page
54
End Page
54

High levels of holding back associated with higher caregiver strain and psychological distress among caregivers of patients with advanced cancer and pain

Authors
Puleo, B; Keefe, F; Bull, J; Hanson, L; Fischer, S; LeBlanc, T; Steel, J; Porter, L
MLA Citation
Puleo, B, Keefe, F, Bull, J, Hanson, L, Fischer, S, LeBlanc, T, Steel, J, and Porter, L. "High levels of holding back associated with higher caregiver strain and psychological distress among caregivers of patients with advanced cancer and pain.": WILEY, February 1, 2018.
Source
wos
Published In
Psycho Oncology
Volume
27
Publish Date
2018
Start Page
54
End Page
54

Acute Leukemia Patients' Needs: Qualitative Findings and Opportunities for Early Palliative Care.

Patients with acute leukemias likely have needs that palliative care can respond to, yet little is known about specific challenges they face, particularly during active treatment. We examined acute myeloid leukemia (AML) patients' expressed challenges and supports after intensive induction chemotherapy.We aimed to understand opportunities for palliative care interventions in this population.We conducted a qualitative study of AML patients with high-risk disease at Duke University Hospital, Durham, NC. Patients were interviewed about care experiences approximately 3 months after treatment initiation. Multiple coders used descriptive content analysis to identify common and recurrent themes.We analyzed 22 patient transcripts. Sample demographics included 10 (45.5%) females, 12 (54.5%) males, mean age 62 (SD 10.9), 19 (86.4%) non-Hispanic white, and three (13.6%) nonwhite/non-Hispanic. All had high-risk disease, by age, relapse status, or molecular markers. We identified four themes in our analysis: physical symptoms, psychological issues, uncertainty regarding prognosis, and patients' sources of support. Specific challenges noted by patients included feelings of helplessness/hopelessness, activity restriction, fatigue, fevers, caregiver stress, and lack of clarity regarding treatment decision making.AML patients face substantial challenges regarding physical symptoms, psychological distress, and uncertainty regarding prognosis. These challenges signal needs for which palliative care in high-risk AML patients may help. Our findings highlight opportunities to develop targeted palliative care interventions addressing unmet needs in AML patients.

Authors
Boucher, NA; Johnson, KS; LeBlanc, TW
MLA Citation
Boucher, NA, Johnson, KS, and LeBlanc, TW. "Acute Leukemia Patients' Needs: Qualitative Findings and Opportunities for Early Palliative Care." Journal of pain and symptom management 55.2 (February 2018): 433-439.
PMID
28935132
Source
epmc
Published In
Journal of Pain and Symptom Management
Volume
55
Issue
2
Publish Date
2018
Start Page
433
End Page
439
DOI
10.1016/j.jpainsymman.2017.09.014

Comparing the Palliative Care Needs of Patients With Hematologic and Solid Malignancies.

Hematologic cancer patients use palliative care services less frequently than their solid tumor counterparts. Prior work suggests that these patients have a sizable symptom burden, but comparisons between hematologic and solid tumor patients near the end of life are limited.To compare unmet symptom needs in a cohort of hematologic and solid tumor patients referred to specialty palliative care services.Using a novel data registry of initial palliative care encounters, we performed a cross-sectional analysis of cancer patients receiving care across 17 sites within the Global Palliative Care Quality Alliance. We compared clinically-significant symptoms (rated as four or greater in severity) between hematologic and solid tumor patients and performed multivariate logistic regression analyses examining the relationship between symptom burden and tumor type.We identified 1235 cancer patients, 108 of which had hematologic malignancies. Pain, dyspnea, nausea, and anorexia burden were as high among patients with hematologic as those with solid malignancies. Blood cancer patients had higher rates of clinically-significant tiredness (51% vs. 42%; P = 0.03) than solid tumor patients. Finally, blood cancer patients had greater odds of being tired (odds ratio 2.19; CI 1.22-3.91) and drowsy (odds ratio 1.81; CI 1.07-3.07) than solid tumor patients independent of age, gender, race, and performance status.Hematologic and solid tumor patients have significant symptom burden at time of referral to palliative care services. Blood cancer patients may have unique concerns warranting targeted attention, including substantial drowsiness and tiredness. Our findings suggest a need to optimize palliative care usage in the hematologic cancer population.

Authors
Hochman, MJ; Yu, Y; Wolf, SP; Samsa, GP; Kamal, AH; LeBlanc, TW
MLA Citation
Hochman, MJ, Yu, Y, Wolf, SP, Samsa, GP, Kamal, AH, and LeBlanc, TW. "Comparing the Palliative Care Needs of Patients With Hematologic and Solid Malignancies." Journal of Pain and Symptom Management 55.1 (January 2018): 82-88.e1.
PMID
28887271
Source
epmc
Published In
Journal of Pain and Symptom Management
Volume
55
Issue
1
Publish Date
2018
Start Page
82
End Page
88.e1
DOI
10.1016/j.jpainsymman.2017.08.030

Advance Care Planning and Palliative Care Specialists in Malignant Hematology and Stem-Cell Transplantation: On Why It Takes A Village.

Authors
LeBlanc, TW
MLA Citation
LeBlanc, TW. "Advance Care Planning and Palliative Care Specialists in Malignant Hematology and Stem-Cell Transplantation: On Why It Takes A Village." Journal of Oncology Practice 14.1 (January 2018): 3-5.
PMID
28981390
Source
epmc
Published In
J Oncol Pract
Volume
14
Issue
1
Publish Date
2018
Start Page
3
End Page
5
DOI
10.1200/jop.2017.026930

Treatment of Relapsed or Refractory Acute Lymphoblastic Leukemia in Real-World US Practices

Authors
LeBlanc, TW; Borham, A; Su, Y; Hayes, KC; Fielding, R; Benigno, M; Cappelleri, JC
MLA Citation
LeBlanc, TW, Borham, A, Su, Y, Hayes, KC, Fielding, R, Benigno, M, and Cappelleri, JC. "Treatment of Relapsed or Refractory Acute Lymphoblastic Leukemia in Real-World US Practices." 59th Annual Meeting of the American-Society-of-Hematology (ASH). December 9, 2017 - December 12, 2017. Atlanta, GA.: AMER SOC HEMATOLOGY, December 7, 2017.
Source
wos
Published In
Blood
Volume
130
Publish Date
2017

Multiple Myeloma Symptom Burden, Perceived Control, and Quality of Life: Findings from the Cancer Experience Registry

Authors
Zaleta, AK; Miller, MF; McManus, S; Johnson, J; Karten, C; LeBlanc, TW; Cole, CE; Buzaglo, JS
MLA Citation
Zaleta, AK, Miller, MF, McManus, S, Johnson, J, Karten, C, LeBlanc, TW, Cole, CE, and Buzaglo, JS. "Multiple Myeloma Symptom Burden, Perceived Control, and Quality of Life: Findings from the Cancer Experience Registry." 59th Annual Meeting of the American-Society-of-Hematology (ASH). December 9, 2017 - December 12, 2017. Atlanta, GA.: AMER SOC HEMATOLOGY, December 7, 2017.
Source
wos
Published In
Blood
Volume
130
Publish Date
2017

Clinical Outcomes of Microtransplantation for Older Adults with Acute Myeloid Leukemia

Authors
Sung, AD; de Castro, CM; LeBlanc, TW; Long, GD; Adams, DB; Brander, DM; Dave, S; Diehl, LF; Phuong, LD; Hennig, T; Kang, Y; McKinney, MS; Rein, LAM; Sipkins, DA; Yang, Y; Chao, NJ; Rizzieri, DA
MLA Citation
Sung, AD, de Castro, CM, LeBlanc, TW, Long, GD, Adams, DB, Brander, DM, Dave, S, Diehl, LF, Phuong, LD, Hennig, T, Kang, Y, McKinney, MS, Rein, LAM, Sipkins, DA, Yang, Y, Chao, NJ, and Rizzieri, DA. "Clinical Outcomes of Microtransplantation for Older Adults with Acute Myeloid Leukemia." 59th Annual Meeting of the American-Society-of-Hematology (ASH). December 9, 2017 - December 12, 2017. Atlanta, GA.: AMER SOC HEMATOLOGY, December 7, 2017.
Source
wos
Published In
Blood
Volume
130
Publish Date
2017

Perceptions of Prognosis and Treatment Risk in Older Patients with Acute Myeloid Leukemia

Authors
El-Jawahri, A; Abel, GA; Greer, J; Fathi, AT; Steensma, DP; LeBlanc, TW; DeAngelo, DJ; Wadleigh, M; Hobbs, GS; Foster, J; Brunner, AM; Amrein, PC; Stone, RM; Temel, JS
MLA Citation
El-Jawahri, A, Abel, GA, Greer, J, Fathi, AT, Steensma, DP, LeBlanc, TW, DeAngelo, DJ, Wadleigh, M, Hobbs, GS, Foster, J, Brunner, AM, Amrein, PC, Stone, RM, and Temel, JS. "Perceptions of Prognosis and Treatment Risk in Older Patients with Acute Myeloid Leukemia." 59th Annual Meeting of the American-Society-of-Hematology (ASH). December 9, 2017 - December 12, 2017. Atlanta, GA.: AMER SOC HEMATOLOGY, December 7, 2017.
Source
wos
Published In
Blood
Volume
130
Publish Date
2017

Transfusion Dependence and Use of Hospice Among Medicare Beneficiaries with Leukemia

Authors
Olszewski, AJ; Egan, PC; LeBlanc, TW
MLA Citation
Olszewski, AJ, Egan, PC, and LeBlanc, TW. "Transfusion Dependence and Use of Hospice Among Medicare Beneficiaries with Leukemia." 59th Annual Meeting of the American-Society-of-Hematology (ASH). December 9, 2017 - December 12, 2017. Atlanta, GA.: AMER SOC HEMATOLOGY, December 7, 2017.
Source
wos
Published In
Blood
Volume
130
Publish Date
2017

Patient-Reported Distress in Hodgkin Lymphoma Patients on Active Therapy Vs. Long-Term Survivors

Authors
Troy, JD; Locke, SC; Pupa, MR; Feliciano, J; Richhariya, A; LeBlanc, TW
MLA Citation
Troy, JD, Locke, SC, Pupa, MR, Feliciano, J, Richhariya, A, and LeBlanc, TW. "Patient-Reported Distress in Hodgkin Lymphoma Patients on Active Therapy Vs. Long-Term Survivors." 59th Annual Meeting of the American-Society-of-Hematology (ASH). December 9, 2017 - December 12, 2017. Atlanta, GA.: AMER SOC HEMATOLOGY, December 7, 2017.
Source
wos
Published In
Blood
Volume
130
Publish Date
2017

Patient experiences of acute myeloid leukemia: A qualitative study about diagnosis, illness understanding, and treatment decision-making.

Patients with acute myeloid leukemia (AML) face a unique, difficult situation characterized by sudden changes in health, complex information, and pressure to make quick treatment decisions amid sizeable tradeoffs. Yet, little is known about patients' experiences with AML. We used qualitative methods to learn about their experiences with diagnosis and treatment decision-making to identify areas for improvement.We recruited hospitalized patients with AML to participate in semi-structured qualitative interviews about their experiences being diagnosed with AML, receiving information, and making a treatment decision. Interviews were conducted during their hospitalization for induction chemotherapy. We analyzed data by using a constant comparison approach.Thirty-two patients completed an interview. Four main themes emerged: (a) shock and suddenness, (b) difficulty processing information, (c) poor communication, and (d) uncertainty. Patients frequently described their diagnosis as shocking. They also felt that the amount of information was too great and too difficult to process, which negatively impacted their understanding. Patients frequently described a lack of emotional support from clinicians and described uncertainty about their prognosis, the number and nature of available treatments, and what to expect from treatment.Acute myeloid leukemia poses a sudden, emotionally challenging, information-laden situation, where little time is available to make important decisions. This results in difficulty processing information and is sometimes complicated by a lack of emotive communication from clinicians. Results indicate a need for targeted interventions to improve AML patients' understanding of illness and treatment options and to address their traumatic experiences around diagnosis.

Authors
LeBlanc, TW; Fish, LJ; Bloom, CT; El-Jawahri, A; Davis, DM; Locke, SC; Steinhauser, KE; Pollak, KI
MLA Citation
LeBlanc, TW, Fish, LJ, Bloom, CT, El-Jawahri, A, Davis, DM, Locke, SC, Steinhauser, KE, and Pollak, KI. "Patient experiences of acute myeloid leukemia: A qualitative study about diagnosis, illness understanding, and treatment decision-making." December 2017.
PMID
27862591
Source
epmc
Published In
Psycho Oncology
Volume
26
Issue
12
Publish Date
2017
Start Page
2063
End Page
2068
DOI
10.1002/pon.4309

Patient-reported outcomes in cancer care - hearing the patient voice at greater volume.

Recording of patient-reported outcomes (PROs) enables direct measurement of the experiences of patients with cancer. In the past decade, the use of PROs has become a prominent topic in health-care innovation; this trend highlights the role of the patient experience as a key measure of health-care quality. Historically, PROs were used solely in the context of research studies, but a growing body of literature supports the feasibility of electronic collection of PROs, yielding reliable data that are sometimes of better quality than clinician-reported data. The incorporation of electronic PRO (ePRO) assessments into standard health-care settings seems to improve the quality of care delivered to patients with cancer. Such efforts, however, have not been widely adopted, owing to the difficulties of integrating PRO-data collection into clinical workflows and electronic medical-record systems. The collection of ePRO data is expected to enhance the quality of care received by patients with cancer; however, for this approach to become routine practice, uniquely trained people, and appropriate policies and analytical solutions need to be implemented. In this Review, we discuss considerations regarding measurements of PROs, implementation challenges, as well as evidence of outcome improvements associated with the use of PROs, focusing on the centrality of PROs as part of 'big-data' initiatives in learning health-care systems.

Authors
LeBlanc, TW; Abernethy, AP
MLA Citation
LeBlanc, TW, and Abernethy, AP. "Patient-reported outcomes in cancer care - hearing the patient voice at greater volume." Nature Reviews. Clinical Oncology 14.12 (December 2017): 763-772. (Review)
PMID
28975931
Source
epmc
Published In
Nature Reviews. Clinical Oncology
Volume
14
Issue
12
Publish Date
2017
Start Page
763
End Page
772
DOI
10.1038/nrclinonc.2017.153

Effect of Inpatient Palliative Care During Hematopoietic Stem-Cell Transplant on Psychological Distress 6 Months After Transplant: Results of a Randomized Clinical Trial.

Purpose Inpatient palliative care integrated with transplant care improves patients' quality of life (QOL) and symptom burden during hematopoietic stem-cell transplant (HCT). We assessed patients' mood, post-traumatic stress disorder (PTSD) symptoms, and QOL 6 months post-transplant. Methods We randomly assigned 160 patients with hematologic malignancies who underwent autologous or allogeneic HCT to inpatient palliative care integrated with transplant care (n = 81) or transplant care alone (n = 79). At baseline and 6 months post-transplant, we assessed mood, PTSD symptoms, and QOL with the Hospital Anxiety and Depression Scale and Patient Health Questionnaire, PTSD checklist, and Functional Assessment of Cancer Therapy-Bone Marrow Transplant. To assess symptom burden during HCT, we used the Edmonton Symptom Assessment Scale. We used analysis of covariance while controlling for baseline values to examine intervention effects and conducted causal mediation analyses to examine whether symptom burden or mood during HCT mediated the effect of the intervention on 6-month outcomes. Results We enrolled 160 (86%) of 186 potentially eligible patients between August 2014 and January 2016. At 6 months post-transplant, intervention participants reported lower depression symptoms on the Hospital Anxiety and Depression Scale and Patient Health Questionnaire (adjusted mean difference, -1.21 [95% CI, -2.26 to -0.16; P = .024] and -1.63 [95% CI, -3.08 to -0.19; P = .027], respectively) and lower PTSD symptoms (adjusted mean difference, -4.02; 95% CI, -7.18 to -0.86; P = .013), but no difference in QOL or anxiety. Symptom burden and anxiety during HCT hospitalization partially mediated the effect of the intervention on depression and PTSD at 6 months post-transplant. Conclusion Inpatient palliative care integrated with transplant care leads to improvements in depression and PTSD symptoms at 6 months post-transplant. Reduction in symptom burden and anxiety during HCT partially accounts for the effect of the intervention on these outcomes.

Authors
El-Jawahri, A; Traeger, L; Greer, JA; VanDusen, H; Fishman, SR; LeBlanc, TW; Pirl, WF; Jackson, VA; Telles, J; Rhodes, A; Li, Z; Spitzer, TR; McAfee, S; Chen, Y-BA; Temel, JS
MLA Citation
El-Jawahri, A, Traeger, L, Greer, JA, VanDusen, H, Fishman, SR, LeBlanc, TW, Pirl, WF, Jackson, VA, Telles, J, Rhodes, A, Li, Z, Spitzer, TR, McAfee, S, Chen, Y-BA, and Temel, JS. "Effect of Inpatient Palliative Care During Hematopoietic Stem-Cell Transplant on Psychological Distress 6 Months After Transplant: Results of a Randomized Clinical Trial." Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology 35.32 (November 2017): 3714-3721.
PMID
28926288
Source
epmc
Published In
Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology
Volume
35
Issue
32
Publish Date
2017
Start Page
3714
End Page
3721
DOI
10.1200/JCO.2017.73.2800

The Implementation of Measuring What Matters in Research and Practice: Series Commentary.

The Measuring What Matters (MWM) initiative identified 10 indicators of high-quality palliative and hospice care. Members of the AAHPM Research Committee, through a special series of articles, examined applications of the MWM quality indicators in research and practice settings. Many themes were present in these articles, including the important role of electronic health records in quality measurement, challenges and strategies for implementing and tracking measures over time, and the importance of identifying new measures. This article is the final commentary of the series and includes recommendations for next steps in quality measurement.

Authors
Unroe, KT; Ast, K; Chuang, E; Schulman-Green, D; Gramling, R; AAHPM Research Committee Writing Group,
MLA Citation
Unroe, KT, Ast, K, Chuang, E, Schulman-Green, D, Gramling, R, and AAHPM Research Committee Writing Group, . "The Implementation of Measuring What Matters in Research and Practice: Series Commentary." Journal of Pain and Symptom Management 54.5 (November 2017): 772-775.
PMID
28729008
Source
epmc
Published In
Journal of Pain and Symptom Management
Volume
54
Issue
5
Publish Date
2017
Start Page
772
End Page
775
DOI
10.1016/j.jpainsymman.2017.07.030

Use of hospice services among Medicare beneficiaries with acute and chronic leukemias.

Authors
LeBlanc, TW; Olszewski, AJ
MLA Citation
LeBlanc, TW, and Olszewski, AJ. "Use of hospice services among Medicare beneficiaries with acute and chronic leukemias.": American Society of Clinical Oncology (ASCO), November 2017.
Source
crossref
Published In
Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology
Volume
35
Issue
31_suppl
Publish Date
2017
Start Page
68
End Page
68
DOI
10.1200/jco.2017.35.31_suppl.68

Open notes: A qualitative study of oncology patients’ experiences reading their cancer care notes.

Authors
Kayastha, N; Pollak, KI; LeBlanc, TW
MLA Citation
Kayastha, N, Pollak, KI, and LeBlanc, TW. "Open notes: A qualitative study of oncology patients’ experiences reading their cancer care notes.": American Society of Clinical Oncology (ASCO), November 2017.
Source
crossref
Published In
Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology
Volume
35
Issue
31_suppl
Publish Date
2017
Start Page
33
End Page
33
DOI
10.1200/jco.2017.35.31_suppl.33

Perceptions of prognosis and treatment risk in older patients with acute myeloid leukemia (AML).

Authors
Nicholson, S; Abel, GA; Fathi, AT; Steensma, DP; LeBlanc, TW; DeAngelo, DJ; Wadleigh, M; Hobbs, G; Foster, J; Brunner, AM; Amrein, PC; Stone, RM; Temel, JS; El-Jawahri, A
MLA Citation
Nicholson, S, Abel, GA, Fathi, AT, Steensma, DP, LeBlanc, TW, DeAngelo, DJ, Wadleigh, M, Hobbs, G, Foster, J, Brunner, AM, Amrein, PC, Stone, RM, Temel, JS, and El-Jawahri, A. "Perceptions of prognosis and treatment risk in older patients with acute myeloid leukemia (AML).": American Society of Clinical Oncology (ASCO), November 2017.
Source
crossref
Published In
Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology
Volume
35
Issue
31_suppl
Publish Date
2017
Start Page
43
End Page
43
DOI
10.1200/jco.2017.35.31_suppl.43

Integration of Electronic Patient-Reported Outcomes Into Routine Cancer Care: An Analysis of Factors Affecting Data Completeness.

PURPOSE:Routinely collected patient-reported outcomes (PROs) could provide invaluable data to a patient-centered learning health system but are often highly missing in clinical trials. We analyzed our experience with PROs to understand patterns of missing data using electronic collection as part of routine clinical care. METHODS:This is an analysis of a prospectively collected observational database of electronic PROs captured as part of routine clinical care in four different outpatient oncology clinics at an academic referral center. RESULTS:More than 24,000 clinical encounters from 7,655 unique patients are included. Data were collected via an electronic tablet-based survey instrument (Patient Care Monitor, version 2.0), at the time of clinical care, as part of routine care processes. Missing instruments (ie, no items completed) were submitted for 6.8% of clinical encounters, and 15.8% of encounters had missing items. Nearly 90% of all encounters involved < 10% missing items. In multivariable analyses, younger age, private health insurance, being seen in the breast oncology clinic, less time spent on the instrument, and longitudinal care were significantly associated with less missingness. CONCLUSION:Embedding collection of electronic PRO data into routine clinical care yielded low rates of missing data in this real-world, prospectively collected database. In contrast to clinical trial experience, missingness improve with longitudinal care. This approach may be a solution to minimizing missingness of PROs in research or clinical care settings in support of learning health care systems.

Authors
Wysham, NG; Wolf, SP; Samsa, G; Abernethy, AP; LeBlanc, TW
MLA Citation
Wysham, NG, Wolf, SP, Samsa, G, Abernethy, AP, and LeBlanc, TW. "Integration of Electronic Patient-Reported Outcomes Into Routine Cancer Care: An Analysis of Factors Affecting Data Completeness." Jco Clinical Cancer Informatics 1 (November 2017): 1-10.
PMID
30657370
Source
epmc
Published In
Jco Clinical Cancer Informatics
Volume
1
Publish Date
2017
Start Page
1
End Page
10
DOI
10.1200/cci.16.00043

The Prospective Evaluation of the Net Effect of Red Blood Cell Transfusions in Routine Provision of Palliative Care.

BACKGROUND:Red Blood Cell (RBC) transfusions are commonly used in palliative care. RBCs are a finite resource, transfusions carry risks, and the net effect (benefits and harms) is poorly defined for people with life-limiting illnesses. OBJECTIVE:To examine the indications and effects of RBC transfusion in palliative care patients. DESIGN:This international, multisite, prospective consecutive cohort study. SETTING/SUBJECTS:Palliative care patients undergoing RBC transfusion. MEASUREMENTS:Target symptoms (fatigue, breathlessness, generalized weakness, or dizziness) were assessed before transfusion and at day 7 by treating clinicians, using National Cancer Center Institute Common Terminology Criteria for Adverse Events. Assessment of harms was made at day 2. RESULTS:One hundred and one transfusions with day 7 follow-up were collected. Median age was 72.0 (interquartile range 61.5-83.0) years, 58% men, and mean Australia-modified Karnofsky Performance Status (AKPS) of 48 (standard deviation [SD] 17). A mean 2.1 (SD 0.6) unit was tranfused. The target symptoms were fatigue (61%), breathlessness (16%), generalized weakness (12%), dizziness (6%), or other (5%). Forty-nine percent of transfusions improved the primary target symptom, and 78% of transfusions improved at least one of the target symptoms. Harms were infrequent and mild. An AKPS of 40%-50% was associated with higher chances of symptomatic benefit in the target symptom; however, no other predictors of response were identified. CONCLUSIONS:In the largest prospective consecutive case series to date, clinicians generally reported benefit, with minimal harms. Ongoing work is required to define the optimal patient- and clinician-reported hematological and functional outcome measures to optimize the use of donor blood and to minimize transfusion-associated risk.

Authors
To, THM; LeBlanc, TW; Eastman, P; Neoh, K; Agar, MR; To, LB; Rowett, D; Vandersman, Z; Currow, DC
MLA Citation
To, THM, LeBlanc, TW, Eastman, P, Neoh, K, Agar, MR, To, LB, Rowett, D, Vandersman, Z, and Currow, DC. "The Prospective Evaluation of the Net Effect of Red Blood Cell Transfusions in Routine Provision of Palliative Care." Journal of Palliative Medicine 20.10 (October 2017): 1152-1157.
PMID
28598239
Source
epmc
Published In
Journal of Palliative Medicine
Volume
20
Issue
10
Publish Date
2017
Start Page
1152
End Page
1157
DOI
10.1089/jpm.2017.0072

Hope, Phase I Trials, and Palliative Care: So You're Telling Me There's a Chance?

Authors
LeBlanc, TW
MLA Citation
LeBlanc, TW. "Hope, Phase I Trials, and Palliative Care: So You're Telling Me There's a Chance?." Journal of Oncology Practice 13.10 (October 2017): 675-677.
PMID
28850313
Source
epmc
Published In
Journal of Oncology Practice
Volume
13
Issue
10
Publish Date
2017
Start Page
675
End Page
677
DOI
10.1200/jop.2017.026070

Ethics Never Left.

Authors
Sederstrom, N; LeBlanc, TW; Von Roenn, J
MLA Citation
Sederstrom, N, LeBlanc, TW, and Von Roenn, J. "Ethics Never Left." Journal of Oncology Practice 13.10 (October 2017): 663-664.
PMID
28892410
Source
epmc
Published In
Journal of Oncology Practice
Volume
13
Issue
10
Publish Date
2017
Start Page
663
End Page
664
DOI
10.1200/jop.2017.027490

Improvements in Patient and Health System Outcomes Using an Integrated Oncology and Palliative Medicine Approach on a Solid Tumor Inpatient Service.

PURPOSE:Early palliative care (PC) improves outcomes for outpatients with advanced cancer. Its effect on hospitalized patients with cancer is unknown. Herein, we report on the influence of a novel, fully integrated inpatient medical oncology and PC partnership at a tertiary medical center during its first year of implementation. METHODS:We conducted a retrospective, longitudinal, pre- and postintervention cohort study at Duke University Hospital. Pre- and postintervention cohorts were defined as all patients admitted to the solid tumor inpatient service from September 1, 2009, to June 30, 2010, and September 1, 2011 to June 30, 2012, respectively. We extracted patient data, including demographics, cancer diagnosis, disease status, length of stay, intensive care unit transfer rate, discharge disposition, time to emergency department return, time to readmission, and 7- and 30-day emergency department return and readmission rates. Nursing and physician surveys assessed satisfaction. Descriptive statistics, and Kruskal-Wallis and Χ2 tests were used to describe and compare cohorts. A generalized estimating equation accounted for repeated measures. RESULTS:Pre- and postintervention analysis cohorts included 731 and 783 patients, respectively, representing a total of 1,514 patients and 2,353 encounters. Cohorts were similar in baseline characteristics. Statistically significant lower odds in 7-day readmission rates were observed in the postintervention cohort (adjusted odds ratio, 0.76; 95% CI, 0.58 to 1.00; P = .0482). Patients in the postintervention group had a decrease in mean length of stay (-0.30 days; 95% CI, -0.62 to 0.02); P = .0651). We observed a trend for increasing hospice referrals ( P = .0837) and a 15% decrease in intensive care unit transfers ( P = .61). Physicians and nurses universally favored the model. CONCLUSION:A fully integrated inpatient partnership between PC and medical oncology is associated with significant and clinically meaningful improvements in key health system-related outcomes and indicators of quality cancer care.

Authors
Riedel, RF; Slusser, K; Power, S; Jones, CA; LeBlanc, TW; Kamal, AH; Desai, D; Allen, D; Yu, Y; Wolf, S; Galanos, AN
MLA Citation
Riedel, RF, Slusser, K, Power, S, Jones, CA, LeBlanc, TW, Kamal, AH, Desai, D, Allen, D, Yu, Y, Wolf, S, and Galanos, AN. "Improvements in Patient and Health System Outcomes Using an Integrated Oncology and Palliative Medicine Approach on a Solid Tumor Inpatient Service." Journal of Oncology Practice 13.9 (September 2017): e738-e748.
PMID
28796559
Source
epmc
Published In
J Oncol Pract
Volume
13
Issue
9
Publish Date
2017
Start Page
e738
End Page
e748
DOI
10.1200/jop.2017.022749

Palliative Care Has Come of Age.

Authors
LeBlanc, TW; Sederstrom, N; Spence, R; von Roenn, J
MLA Citation
LeBlanc, TW, Sederstrom, N, Spence, R, and von Roenn, J. "Palliative Care Has Come of Age." Journal of Oncology Practice 13.9 (September 2017): 589-590.
PMID
28829695
Source
epmc
Published In
J Oncol Pract
Volume
13
Issue
9
Publish Date
2017
Start Page
589
End Page
590
DOI
10.1200/jop.2017.026674

The Cambia Sojourns Scholars Leadership Program: Conversations with Emerging Leaders in Palliative Care.

BACKGROUND:There is a pressing workforce shortage and leadership scarcity in palliative care to adequately meet the demands of individuals with serious illness and their families. To address this gap, the Cambia Health Foundation launched its Sojourns Scholars Leadership Program in 2014, an initiative designed to identify, cultivate, and advance the next generation of palliative care leaders. This report intends to summarize the second cohort of Sojourns Scholars' projects and their reflection on their leadership needs. OBJECTIVE:This report summarizes the second cohort of sojourns scholars' project and their reflection on leadership needs. METHODS:After providing a written reflection on their own projects, the second cohort participated in a group interview (fireside chat) to elicit their perspectives on barriers and facilitators in providing palliative care, issues facing leadership in palliative care in the United States, and lessons from personal and professional growth as leaders in palliative care. They analyzed the transcript of the group interview using qualitative content analysis methodology. RESULTS:Three themes emerged from descriptions of the scholars' project experience: challenges in palliative care practice, leadership strategies in palliative care, and three lessons learned to be a leader were identified. Challenges included perceptions of palliative care, payment and policy, and workforce development. Educating and collaborating with other clinicians and influencing policy change are important strategies used to advance palliative care. Time management, leading team effort, and inspiring others are important skills that promote effectiveness as a leader. DISCUSSION:Emerging leaders have a unique view of conceptualizing contemporary palliative care and shaping the future. CONCLUSIONS:Providing comprehensive, coordinated care that is high quality, patient and family centered, and readily available depends on strong leadership in palliative care. The Cambia Scholars Program represents a unique opportunity.

Authors
Cruz-Oliver, DM; Bernacki, R; Cooper, Z; Grudzen, C; Izumi, S; Lafond, D; Lam, D; LeBlanc, TW; Tjia, J; Walter, J
MLA Citation
Cruz-Oliver, DM, Bernacki, R, Cooper, Z, Grudzen, C, Izumi, S, Lafond, D, Lam, D, LeBlanc, TW, Tjia, J, and Walter, J. "The Cambia Sojourns Scholars Leadership Program: Conversations with Emerging Leaders in Palliative Care." Journal of Palliative Medicine 20.8 (August 2017): 804-812.
PMID
28525294
Source
epmc
Published In
Journal of Palliative Medicine
Volume
20
Issue
8
Publish Date
2017
Start Page
804
End Page
812
DOI
10.1089/jpm.2017.0182

Early Palliative Care for Patients with Hematologic Malignancies: Is It Really so Difficult to Achieve?

Evidence points to many benefits of "early palliative care," the provision of specialist palliative care services upstream from the end of life, to improve patients' quality of life while living with a serious illness. Yet most trials of early palliative care have not included patients with hematologic malignancies. Unfortunately, patients with hematologic malignancies are also known to have substantial illness burden, poor quality of life, and aggressive care at the end of life, including a greater likelihood of dying in the hospital, receiving chemotherapy at the end of life, and low hospice utilization, compared to patients with solid tumors. Given these unmet needs, one must wonder, why is palliative care so underutilized in this population? In this article, we discuss barriers to palliative care integration in hematology, highlight several reports of successful integration, and suggest specific indications for involving palliative care in the management of hematologic malignancy patients.

Authors
LeBlanc, TW; Roeland, EJ; El-Jawahri, A
MLA Citation
LeBlanc, TW, Roeland, EJ, and El-Jawahri, A. "Early Palliative Care for Patients with Hematologic Malignancies: Is It Really so Difficult to Achieve?." Current hematologic malignancy reports 12.4 (August 2017): 300-308. (Review)
PMID
28639084
Source
epmc
Published In
Current Hematologic Malignancy Reports
Volume
12
Issue
4
Publish Date
2017
Start Page
300
End Page
308
DOI
10.1007/s11899-017-0392-z

Risk tolerance and attitudes toward chemotherapy: Who chooses palliative treatment when cure is possible?

Authors
LeBlanc, TW; Scherr, K; Wang, A; Lemmon, M; Ubel, PA
MLA Citation
LeBlanc, TW, Scherr, K, Wang, A, Lemmon, M, and Ubel, PA. "Risk tolerance and attitudes toward chemotherapy: Who chooses palliative treatment when cure is possible?.": American Society of Clinical Oncology (ASCO), May 20, 2017.
Source
crossref
Published In
Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology
Volume
35
Issue
15_suppl
Publish Date
2017
Start Page
10054
End Page
10054
DOI
10.1200/jco.2017.35.15_suppl.10054

Patient-reported distress in myelodysplastic syndromes and its relationship with clinical outcomes.

Authors
Troy, JD; deCastro, C; Pupa, MR; Samsa, GP; Abernethy, AP; LeBlanc, TW
MLA Citation
Troy, JD, deCastro, C, Pupa, MR, Samsa, GP, Abernethy, AP, and LeBlanc, TW. "Patient-reported distress in myelodysplastic syndromes and its relationship with clinical outcomes.": American Society of Clinical Oncology (ASCO), May 20, 2017.
Source
crossref
Published In
Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology
Volume
35
Issue
15_suppl
Publish Date
2017
Start Page
e21564
End Page
e21564
DOI
10.1200/jco.2017.35.15_suppl.e21564

Assessing Psychological Toxicity and Patient-Reported Distress as the Sixth Vital Sign in Cancer Care and Clinical Trials.

As the number of available cancer therapies continues to grow, there is increasing interest in their impact on cancer patients' lived experiences. Screening for distress is one way to measure psychological dimensions of cancer patients' experiences, and doing so is increasingly part of standard operations at major cancer centers across the US. To date, however, most clinical trials have not adequately captured patients' experiences as part of their outcome assessments, so clinicians lack data needed to guide their responses to psychological features of patients' illness experiences. As distress becomes the "sixth vital sign" in routine cancer care, we argue that clinical trials should assess patients' experiences in the same way that they robustly screen for adverse events and toxicities. New interventions are needed to address distress.

Authors
LeBlanc, TW; Kamal, AH
MLA Citation
LeBlanc, TW, and Kamal, AH. "Assessing Psychological Toxicity and Patient-Reported Distress as the Sixth Vital Sign in Cancer Care and Clinical Trials." AMA journal of ethics 19.5 (May 2017): 460-466.
PMID
28553903
Source
epmc
Published In
Ama Journal of Ethics
Volume
19
Issue
5
Publish Date
2017
Start Page
460
End Page
466
DOI
10.1001/journalofethics.2017.19.5.stas1-1705

Harmonization of patient-reported outcomes into EHRs at four cancer hospital outpatient clinics for patient care and quality assessment.

Authors
Chung, A; Stover, AM; Wagner, LI; LeBlanc, TW; Topalaglu, U; Zafar, Y
MLA Citation
Chung, A, Stover, AM, Wagner, LI, LeBlanc, TW, Topalaglu, U, and Zafar, Y. "Harmonization of patient-reported outcomes into EHRs at four cancer hospital outpatient clinics for patient care and quality assessment." 53rd Annual Clinical Meeting of the American-Society-of-Clinical-Oncology (ASCO). June 2, 2017 - June 7, 2017. Chicago, IL.: AMER SOC CLINICAL ONCOLOGY, March 10, 2017.
Source
wos
Published In
Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology
Volume
35
Issue
8
Publish Date
2017

Operationalizing the Measuring What Matters Spirituality Quality Metric in a Population of Hospitalized, Critically Ill Patients and Their Family Members.

Measuring What Matters (MWM) quality indicators support measurement of the percentage of patients who have spiritual discussions, if desired.The objective of this study was to 1) determine the ease of, and barriers to, prospectively collecting MWM spirituality quality measure data and 2) further explore the importance of spirituality in a seriously ill, hospitalized population of critically ill patients and their family members.Electronic medical record (EMR) review and cross-sectional survey of intensive care unit (ICU) patients and their family members from October to December 2015. Participants were in four adult ICUs totaling 68 beds at a single academic, urban, tertiary care center which has ICU-assigned chaplains and an in-house, 24-hour, on-call chaplain.All patients had a "Spiritual Risk Screen" which included two questions identifying patient religion and whether a chaplain visit was desired. Approximately 2/3 of ICU patients were eligible, and there were 144 respondents (50% female; 57% patient and 43% family member), with the majority being Caucasian or African American (68% and 21%, respectively). Common religious identifications were Christian or no faith tradition (76% and 11%, respectively). Approximately half of patients had an EMR chaplain note although it did not document presence of a "spiritual discussion." No study patients received palliative care consultation. A majority (85%) noted that spirituality was "important to them" and that prevalence remained high across respondent age, race, faith tradition, or admitting ICU.Operationalizing the MWM spirituality quality indicator was challenging as elements of a "spiritual screening" or documentation of a "spiritual discussion" were not clearly documented in the EMR. The high prevalence of spirituality among respondents validates the importance of spirituality as a potential quality metric.

Authors
Aslakson, RA; Kweku, J; Kinnison, M; Singh, S; Crowe, TY; AAHPM Writing Group,
MLA Citation
Aslakson, RA, Kweku, J, Kinnison, M, Singh, S, Crowe, TY, and AAHPM Writing Group, . "Operationalizing the Measuring What Matters Spirituality Quality Metric in a Population of Hospitalized, Critically Ill Patients and Their Family Members." Journal of pain and symptom management 53.3 (March 2017): 650-655.
PMID
28042059
Source
epmc
Published In
Journal of Pain and Symptom Management
Volume
53
Issue
3
Publish Date
2017
Start Page
650
End Page
655
DOI
10.1016/j.jpainsymman.2016.12.323

A Rising Tide Lifts All Boats: the Palliative Care Research Cooperative (PCRC) as a Resource to Improve the Science of Palliative Care (TH331)

Authors
Kutner, JS; Harrison, K; Ritchie, C; Ferrell, B; Furuno, JP; LeBlanc, T; Pollak, K
MLA Citation
Kutner, JS, Harrison, K, Ritchie, C, Ferrell, B, Furuno, JP, LeBlanc, T, and Pollak, K. "A Rising Tide Lifts All Boats: the Palliative Care Research Cooperative (PCRC) as a Resource to Improve the Science of Palliative Care (TH331)." February 2017.
Source
crossref
Published In
Journal of Pain and Symptom Management
Volume
53
Issue
2
Publish Date
2017
Start Page
329
End Page
330
DOI
10.1016/j.jpainsymman.2016.12.055

Acute Leukemia Patients’ Unmet Needs: Qualitative Findings and Suggested Opportunities for Early Palliative Care (SA527A)

Authors
Boucher, N; Johnson, K; LeBlanc, T
MLA Citation
Boucher, N, Johnson, K, and LeBlanc, T. "Acute Leukemia Patients’ Unmet Needs: Qualitative Findings and Suggested Opportunities for Early Palliative Care (SA527A).": Elsevier BV, February 2017.
Source
crossref
Published In
Journal of Pain and Symptom Management
Volume
53
Issue
2
Publish Date
2017
Start Page
407
End Page
408
DOI
10.1016/j.jpainsymman.2016.12.206

Oncologist in My Pocket: What the Hospice & Palliative Provider Needs to Know About Hematology/Oncology (P16)

Authors
Newport, K; Bobb, BT; LeBlanc, T; Sivendran, S
MLA Citation
Newport, K, Bobb, BT, LeBlanc, T, and Sivendran, S. "Oncologist in My Pocket: What the Hospice & Palliative Provider Needs to Know About Hematology/Oncology (P16)." February 2017.
Source
crossref
Published In
Journal of Pain and Symptom Management
Volume
53
Issue
2
Publish Date
2017
Start Page
310
End Page
311
DOI
10.1016/j.jpainsymman.2016.12.016

Concordance Between Veterans' Self-Report and Documentation of Surrogate Decision Makers: Implications for Quality Measurement.

The Measuring What Matters initiative of the American Academy of Hospice and Palliative Medicine and the Hospice and Palliative Nurses Association identified documentation of a surrogate decision maker as one of the top 10 quality indicators in the acute hospital and hospice settings.To better understand the potential implementation of this Measuring What Matters quality measure #8, Documentation of Surrogate in outpatient primary care settings by describing primary care patients' self-reported identification and documentation of a surrogate decision maker.Examination of patient responses to self-assessment questions from advance health care planning educational groups conducted in one medical center primary care clinic and seven community-based outpatient primary care clinics. We assessed the concordance between patient reports of identifying and naming a surrogate decision maker and having completed an advance directive (AD) with presence of an AD in the electronic medical record.Of veterans without a documented AD on file, more than half (66%) reported that they had talked with someone they trusted and nearly half (52%) reported that they had named someone to communicate their preferences.Our clinical project data suggest that many more veterans may have initiated communications with surrogate decision makers than is evident in the electronic medical record. System changes are needed to close the gap between veterans' plans for a surrogate decision maker and the documentation available to acute care health care providers.

Authors
Garner, KK; Dubbert, P; Lensing, S; Sullivan, DH; AAHPM Research Committee Writing Group,
MLA Citation
Garner, KK, Dubbert, P, Lensing, S, Sullivan, DH, and AAHPM Research Committee Writing Group, . "Concordance Between Veterans' Self-Report and Documentation of Surrogate Decision Makers: Implications for Quality Measurement." Journal of pain and symptom management 53.1 (January 2017): 1-4.
PMID
27876636
Source
epmc
Published In
Journal of Pain and Symptom Management
Volume
53
Issue
1
Publish Date
2017
Start Page
1
End Page
4
DOI
10.1016/j.jpainsymman.2016.10.356

Risk stratification, treatment selection, and transplant eligibility in multiple myeloma: a qualitative study of the perspectives and self-reported practices of oncologists.

Since the early 2000s, treatment options for multiple myeloma have rapidly expanded, adding significant complexity to the management of this disease. To our knowledge, no systematic qualitative research on clinical decision-making in multiple myeloma has been published. We sought to characterize how physicians view and implement guidelines and incorporate novel approaches into patient care.We designed a semi-structured qualitative interview guide informed by literature review and an expert advisory panel. We conducted 60-minute interviews with a diverse sample of oncology physicians in the southeast United States. We used a constant comparative method to code and analyze interview transcripts. The research team and advisory panel discussed and validated emergent themes.Participants were 13 oncologists representing 5 academic and 4 community practices. Academic physicians reported using formal risk-stratification schemas; community physicians typically did not. Physicians also described differences in eligibility criteria for transplantation; community physicians emphasized distance, social support, and psychosocial capacity in making decisions about transplantation referral; the academic physicians reported using more specific clinical criteria. All physicians reported using a maintenance strategy both for post-transplant and for transplant-ineligible patients; however, determining the timing of maintenance therapy initiation and the response were reported as challenging, as was recognition or definition of relapse, especially in terms of when treatment re-initiation is indicated.Practices reported by both academic and community physicians suggest opportunities for interventions to improve patient care and outcomes through optimal multiple myeloma management and therapy selection. Community physicians in particular might benefit from targeted education interventions about risk stratification, transplant eligibility, and novel therapies.

Authors
LeBlanc, TW; Howson, A; Turell, W; Sheldon, P; Locke, SC; Tuchman, SA; Gasparetto, C; Kaura, S; Khan, ZM; Abernethy, AP
MLA Citation
LeBlanc, TW, Howson, A, Turell, W, Sheldon, P, Locke, SC, Tuchman, SA, Gasparetto, C, Kaura, S, Khan, ZM, and Abernethy, AP. "Risk stratification, treatment selection, and transplant eligibility in multiple myeloma: a qualitative study of the perspectives and self-reported practices of oncologists." Current Oncology (Toronto, Ont.) 23.6 (December 21, 2016): e598-e604.
PMID
28050150
Source
epmc
Published In
Current Oncology (Toronto, Ont.)
Volume
23
Issue
6
Publish Date
2016
Start Page
e598
End Page
e604
DOI
10.3747/co.23.3298

Palliative and End-of-Life Care in Myelodysplastic Syndromes.

A growing literature demonstrates that MDS is associated with significant impairments in overall quality of life. Given the poor prognosis for many patients with MDS, and the considerable morbidities associated with this disease, there is a critical need to address palliative and end-of-life care needs in this population. However, palliative and end-of-life care issues are under-represented in the MDS literature. In this article, we highlight a growing body of literature that demonstrates unmet palliative and end-of-life care needs in hematologic malignancies, including MDS, and highlight opportunities for further research and quality improvement initiatives to address unmet needs in MDS care.

Authors
Nickolich, M; El-Jawahri, A; LeBlanc, TW
MLA Citation
Nickolich, M, El-Jawahri, A, and LeBlanc, TW. "Palliative and End-of-Life Care in Myelodysplastic Syndromes." Current hematologic malignancy reports 11.6 (December 2016): 434-440. (Review)
PMID
27704467
Source
epmc
Published In
Current Hematologic Malignancy Reports
Volume
11
Issue
6
Publish Date
2016
Start Page
434
End Page
440
DOI
10.1007/s11899-016-0352-z

Adherence to Measuring What Matters Items When Caring for Patients With Hematologic Malignancies Versus Solid Tumors.

Measuring What Matters (MWM) prioritizes quality measures in palliative care practice. Hematologic malignancy patients are less likely to access palliative care, yet little is known about their unique needs. Differences in MWM adherence may highlight opportunities to improve palliative care in hematology.To assess adherence to MWM measures by palliative care clinicians caring for patients with hematologic malignancies, compared to those with solid tumors.We used the Quality Data Collection Tool to assess completion of MWM measures across nine sites.We included data from 678 patients' first visits and various care settings; 64 (9.4%) had a hematologic malignancy, whereas 614 (90.6%) had a solid tumor. Hematology patients were more likely to be seen in a hospital (52 or 81.3% vs. 420 or 68%), whereas solid tumor patients were more frequently seen at home or in clinics (160 or 26% vs. 7 or 10.9%). Of the nine MWM measures we assessed, high adherence (>90%) was seen regardless of tumor type in measures #3 (Pain Treatment), #7 (Spiritual Concerns), #8 (Treatment Preferences), and #9 (Care Consistent With Preferences). Clinicians seeing hematology patients were significantly less likely to meet measures #2 (Screening for Physical Symptoms; 57.8% vs. 84.2%, P < 0.001), and #5 (Discussion of Emotional Needs; 56.3% vs. 70.0%, P = 0.03).MWM adherence regarding symptom assessment and meeting emotional needs was lower for patients with hematologic malignancies compared to those with solid tumors. This finding suggests two key areas for quality improvement initiatives in palliative care for patients with hematologic malignancies.

Authors
LeBlanc, TW; Ritchie, CS; Friedman, F; Bull, J; Kutner, JS; Johnson, KS; Kamal, AH; AAHPM Research Committee Writing Group,
MLA Citation
LeBlanc, TW, Ritchie, CS, Friedman, F, Bull, J, Kutner, JS, Johnson, KS, Kamal, AH, and AAHPM Research Committee Writing Group, . "Adherence to Measuring What Matters Items When Caring for Patients With Hematologic Malignancies Versus Solid Tumors." Journal of Pain and Symptom Management 52.6 (December 2016): 775-782.
PMID
27810570
Source
epmc
Published In
Journal of Pain and Symptom Management
Volume
52
Issue
6
Publish Date
2016
Start Page
775
End Page
782
DOI
10.1016/j.jpainsymman.2016.09.004

Anticholinergic Drug Burden in Noncancer Versus Cancer Patients Near the End of Life.

Anticholinergic drugs can cause several side effects, impairing cognition and quality of life (QOL). Cancer patients are often exposed to increasing cumulative anticholinergic load (ACL) as they approach death, but this burden has not been examined in patients with nonmalignant diseases.To determine ACL and its impact in noncancer versus cancer palliative care patients.We performed a secondary analysis of 244 subjects enrolled in a randomized controlled trial. ACL was quantified with the Anticholinergic Drug Scale. We used multivariable regression to calculate the effect of ACL on key outcomes, including drowsiness, fatigue, and QOL. Patients were stratified by diagnosis, and drugs were grouped as symptom management (SM) or disease management (DM).Overall, ACL in cancer and noncancer patients was not significantly different (2.6 vs. 2.4; P = 0.23). SM drugs caused greater anticholinergic exposure than DM drugs in both cancer and noncancer patients (2.3 vs. 0.5, and 1.5 vs. 1.3, respectively; both P < 0.05); however, DM drugs exposed noncancer patients to relatively more ACL than cancer patients (1.2 vs. 0.6, P < 0.0001). ACL was associated with worse fatigue (odds ratio, 1.08; CI, 1.002-1.17) and worse QOL (odds ratio, 0.89; CI, 0.80-0.98).ACL is associated with worse fatigue and QOL and may not differ significantly between cancer and noncancer patients nearing end of life. SM drugs are more responsible for ACL in cancer and noncancer patients, although DM drugs contribute significantly to ACL in the latter group. We recommend more attention to reducing anticholinergic use in all patients with life-limiting illness.

Authors
Hochman, MJ; Kamal, AH; Wolf, SP; Samsa, GP; Currow, DC; Abernethy, AP; LeBlanc, TW
MLA Citation
Hochman, MJ, Kamal, AH, Wolf, SP, Samsa, GP, Currow, DC, Abernethy, AP, and LeBlanc, TW. "Anticholinergic Drug Burden in Noncancer Versus Cancer Patients Near the End of Life." Journal of Pain and Symptom Management 52.5 (November 2016): 737-743.e3.
PMID
27663186
Source
epmc
Published In
Journal of Pain and Symptom Management
Volume
52
Issue
5
Publish Date
2016
Start Page
737
End Page
743.e3
DOI
10.1016/j.jpainsymman.2016.03.020

Cancer Cachexia: Beyond Weight Loss.

Cancer cachexia is a multifactorial syndrome characterized by skeletal muscle loss leading to progressive functional impairment. Despite the ubiquity of cachexia in clinical practice, prevention, early identification, and intervention remain challenging. The impact of cancer cachexia on quality of life, treatment-related toxicity, physical function, and mortality are well established; however, establishing a clinically meaningful definition has proven challenging because of the focus on weight loss alone. Attempts to more comprehensively define cachexia through body composition, physical functioning, and molecular biomarkers, while promising, are yet to be routinely incorporated into clinical practice. Pharmacologic agents that have not been approved by the US Food and Drug Administration but that are currently used in cancer cachexia (ie, megestrol, dronabinol) may improve weight but not outcomes of interest such as muscle mass, physical activity, or mortality. Their routine use is limited by adverse effects. For the practicing oncologist, early identification and management of cachexia is critical. Oncologists must recognize cachexia beyond weight loss alone, focusing instead on body composition and physical functioning. In fact, becoming emaciated is a late sign of cachexia that characterizes its refractory stage. Given that cachexia is a multifactorial syndrome, it requires early identification and polymodal intervention, including optimal cancer therapy, symptom management, nutrition, exercise, and psychosocial support. Consequently, oncologists have a role in ensuring that these resources are available to their patients. In addition, in light of the promising investigational agents, it remains imperative to refer patients with cachexia to clinical trials so that available options can be expanded to effectively treat this pervasive problem.

Authors
Bruggeman, AR; Kamal, AH; LeBlanc, TW; Ma, JD; Baracos, VE; Roeland, EJ
MLA Citation
Bruggeman, AR, Kamal, AH, LeBlanc, TW, Ma, JD, Baracos, VE, and Roeland, EJ. "Cancer Cachexia: Beyond Weight Loss." Journal of Oncology Practice 12.11 (November 2016): 1163-1171. (Review)
PMID
27858548
Source
epmc
Published In
J Oncol Pract
Volume
12
Issue
11
Publish Date
2016
Start Page
1163
End Page
1171
DOI
10.1200/jop.2016.016832

Effect of Inpatient Palliative Care on Quality of Life 2 Weeks After Hematopoietic Stem Cell Transplantation: A Randomized Clinical Trial.

During hospitalization for hematopoietic stem cell transplantation (HCT), patients receive high-dose chemotherapy before transplantation and experience significant physical and psychological symptoms and poor quality of life (QOL).To assess the effect of inpatient palliative care on patient- and caregiver-reported outcomes during hospitalization for HCT and 3 months after transplantation.Nonblinded randomized clinical trial among 160 adults with hematologic malignancies undergoing autologous/allogeneic HCT and their caregivers (n = 94). The study was conducted from August 2014 to January 2016 in a Boston hospital; follow-up was completed in May 2016.Patients assigned to the intervention (n=81) were seen by palliative care clinicians at least twice a week during HCT hospitalization; the palliative intervention was focused on management of physical and psychological symptoms. Patients assigned to standard transplant care (n=79) could be seen by palliative care clinicians on request.Primary: change in patient QOL from baseline to week 2; secondary: patient-assessed mood, fatigue, and symptom burden scores at baseline, 2 weeks, and 3 months after HCT and caregiver-assessed QOL and mood at baseline and 2 weeks after HCT.Among 160 enrolled patients (mean age, 60 [SD, 13.3] years; 91 women [56.9%]; median hospital stay, 21 days) and 94 caregivers, 157 (98.1%) and 89 (94.7%), respectively, completed 2-week follow-up, and 149 patients (93.1%) completed 3-month follow-up. Patients in the intervention group reported a smaller decrease in QOL from baseline to week 2 (mean baseline score, 110.26; week 2 score, 95.46; mean change, -14.72) compared with patients in the control group (mean baseline score, 106.83; week 2 score, 85.42; mean change, -21.54; difference between groups, -6.82; 95% CI, -13.48 to -0.16; P = .045). Among the secondary outcomes, from baseline to week 2, patients in the intervention group vs those in the control group had less increase in depression (mean, 2.43 vs 3.94; mean difference, 1.52; 95% CI, 0.23-2.81; P = .02), lower anxiety (mean, -0.80 vs 1.12; mean difference, 1.92; 95% CI, 0.83-3.01; P < .001), no difference in fatigue (mean, -10.30 vs -13.65; mean difference, -3.34; 95% CI, -7.25 to 0.56; P = .09), and less increase in symptom burden (mean, 17.35 vs 23.14; mean difference, 5.80; 95% CI, 0.49-11.10; P = .03). At 3 months after HCT, intervention patients vs control patients had higher QOL scores (mean, 112.00 vs 106.66; mean difference, 5.34; 95% CI, 0.04-10.65; P = .048) and less depression symptoms (mean, 3.49 vs 5.19; mean difference, -1.70; 95% CI, -2.75 to -0.65; P = .002) but no significant differences in anxiety, fatigue, or symptom burden. From baseline to week 2 after HCT, caregivers of patients in the intervention group vs caregivers of patients in the control group reported no significant differences in QOL or anxiety but had a smaller increase in depression (mean, 0.25 vs 1.80; mean difference, 1.55; 95% CI, 0.14-2.96; P = .03).Among adults at a single institution undergoing HCT for hematologic malignancy, the use of inpatient palliative care compared with standard transplant care resulted in a smaller decrease in QOL 2 weeks after transplantation. Further research is needed for replication and to assess longer-term outcomes and cost implications.clinicaltrials.gov Identifier: NCT02207322.

Authors
El-Jawahri, A; LeBlanc, T; VanDusen, H; Traeger, L; Greer, JA; Pirl, WF; Jackson, VA; Telles, J; Rhodes, A; Spitzer, TR; McAfee, S; Chen, Y-BA; Lee, SS; Temel, JS
MLA Citation
El-Jawahri, A, LeBlanc, T, VanDusen, H, Traeger, L, Greer, JA, Pirl, WF, Jackson, VA, Telles, J, Rhodes, A, Spitzer, TR, McAfee, S, Chen, Y-BA, Lee, SS, and Temel, JS. "Effect of Inpatient Palliative Care on Quality of Life 2 Weeks After Hematopoietic Stem Cell Transplantation: A Randomized Clinical Trial." Jama 316.20 (November 2016): 2094-2103.
PMID
27893130
Source
epmc
Published In
Jama
Volume
316
Issue
20
Publish Date
2016
Start Page
2094
End Page
2103
DOI
10.1001/jama.2016.16786

Inpatient integrated palliative and transplant care to improve family caregiver (FC) outcomes of patients hospitalized for hematopoietic stem cell transplantation (HCT).

Authors
VanDusen, H; LeBlanc, TW; Traeger, L; Greer, JA; Pirl, WF; Jackson, VA; Telles, J; Rhodes, A; Chen, Y-BA; Temel, JS; El-Jawahri, A
MLA Citation
VanDusen, H, LeBlanc, TW, Traeger, L, Greer, JA, Pirl, WF, Jackson, VA, Telles, J, Rhodes, A, Chen, Y-BA, Temel, JS, and El-Jawahri, A. "Inpatient integrated palliative and transplant care to improve family caregiver (FC) outcomes of patients hospitalized for hematopoietic stem cell transplantation (HCT).": American Society of Clinical Oncology (ASCO), October 9, 2016.
Source
crossref
Published In
Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology
Volume
34
Issue
26_suppl
Publish Date
2016
Start Page
235
End Page
235
DOI
10.1200/jco.2016.34.26_suppl.235

Sleep quality among inpatients with acute myeloid leukemia.

Authors
LeBlanc, TW; Aibel, K; Meyerhoff, R; Harpole, D; Abernethy, AP; Yang, C-FJ
MLA Citation
LeBlanc, TW, Aibel, K, Meyerhoff, R, Harpole, D, Abernethy, AP, and Yang, C-FJ. "Sleep quality among inpatients with acute myeloid leukemia.": American Society of Clinical Oncology (ASCO), October 9, 2016.
Source
crossref
Published In
Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology
Volume
34
Issue
26_suppl
Publish Date
2016
Start Page
82
End Page
82
DOI
10.1200/jco.2016.34.26_suppl.82

Patient-reported distress in adults with myelodysplastic syndromes (MDS).

Authors
Troy, JD; deCastro, C; Pupa, MR; Samsa, GP; Abernethy, AP; LeBlanc, TW
MLA Citation
Troy, JD, deCastro, C, Pupa, MR, Samsa, GP, Abernethy, AP, and LeBlanc, TW. "Patient-reported distress in adults with myelodysplastic syndromes (MDS).": American Society of Clinical Oncology (ASCO), October 9, 2016.
Source
crossref
Published In
Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology
Volume
34
Issue
26_suppl
Publish Date
2016
Start Page
80
End Page
80
DOI
10.1200/jco.2016.34.26_suppl.80

Who chooses palliative chemotherapy when a cure is possible? Results of a risk tolerance survey of laypersons.

Authors
LeBlanc, TW; Scherr, K; Wang, A; Lemmon, M; Ubel, PA
MLA Citation
LeBlanc, TW, Scherr, K, Wang, A, Lemmon, M, and Ubel, PA. "Who chooses palliative chemotherapy when a cure is possible? Results of a risk tolerance survey of laypersons.": American Society of Clinical Oncology (ASCO), October 9, 2016.
Source
crossref
Published In
Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology
Volume
34
Issue
26_suppl
Publish Date
2016
Start Page
35
End Page
35
DOI
10.1200/jco.2016.34.26_suppl.35

Randomized trial of inpatient palliative care in patients hospitalized for hematopoietic stem cell transplantation (HCT).

Authors
El-Jawahri, A; LeBlanc, TW; VanDusen, H; Traeger, L; Greer, JA; Pirl, WF; Jackson, VA; Telles, J; Rhodes, A; Chen, Y-BA; Temel, JS
MLA Citation
El-Jawahri, A, LeBlanc, TW, VanDusen, H, Traeger, L, Greer, JA, Pirl, WF, Jackson, VA, Telles, J, Rhodes, A, Chen, Y-BA, and Temel, JS. "Randomized trial of inpatient palliative care in patients hospitalized for hematopoietic stem cell transplantation (HCT).": American Society of Clinical Oncology (ASCO), October 9, 2016.
Source
crossref
Published In
Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology
Volume
34
Issue
26_suppl
Publish Date
2016
Start Page
103
End Page
103
DOI
10.1200/jco.2016.34.26_suppl.103

Association of Practice-Level Hospital Use With End-of-Life Outcomes, Readmission, and Weekend Hospitalization Among Medicare Beneficiaries With Cancer.

To determine the relationships between hospital use of treating oncology practices and patient outcomes.Retrospective analysis of 397,646 Medicare beneficiaries who received anticancer therapy in 2012. Each beneficiary was associated with a practice; practices were ranked on the basis of risk-adjusted hospital use, that is, inpatient intensity. Outcomes included 30-day readmission, weekend admissions, intensive care unit stays in the last month of life, and hospice stay of ≥ 7 days. Outcomes were measured for each quartile of practice-level inpatient intensity. We fit multivariable logistic regression models to calculate adjusted odds ratios (ORs) for each outcome for each quartile of inpatient intensity.Total 30-day readmissions were 22.8% and 31.9% (OR, 1.45; 95% CI, 1.39 to 1.50) for patients in practices with the lowest versus highest quartiles of inpatient intensity, respectively; unplanned readmissions were 19.8% and 27.1% (OR, 1.36; 95% CI, 1.31 to 1.41), respectively. The proportion of admissions that occurred on weekends was similar across quartiles. Patients of practices in the highest quartiles of inpatient intensity had higher rates of death in an ICU stay in the last month of life (25.5% versus 18.0%; OR, 1.33; 95% CI, 1.19 to 1.49) and a lower rate of hospice stay of at least 7 days (50.9% to 42.5%; OR, 0.79; 95% CI, 0.74 to 0.86).Medical oncology practices that seek to reduce hospitalizations should consider focusing initially on processes related to end-of-life care and care transitions.

Authors
Clough, JD; Strawbridge, LM; LeBlanc, TW; Hammill, BG; Kamal, AH
MLA Citation
Clough, JD, Strawbridge, LM, LeBlanc, TW, Hammill, BG, and Kamal, AH. "Association of Practice-Level Hospital Use With End-of-Life Outcomes, Readmission, and Weekend Hospitalization Among Medicare Beneficiaries With Cancer." Journal of Oncology Practice 12.10 (October 2016): e933-e943.
PMID
27531384
Source
epmc
Published In
J Oncol Pract
Volume
12
Issue
10
Publish Date
2016
Start Page
e933
End Page
e943
DOI
10.1200/jop.2016.013102

Pretransplantation Supportive and Palliative Care Consultation for High-Risk Hematopoietic Cell Transplantation Patients.

Early palliative care (EPC) for patients with metastatic solid tumors is now standard of care, but the effect of EPC in hematopoietic cell transplantation (HCT) is less well understood. We studied the acceptability of pre-HCT EPC as measured by trial participation, changes in patient-reported outcomes, and follow-up with palliative care providers. English-speaking adults (age >17 years) with an HCT comorbidity index of ≥ 3, relapse risk > 25%, or planned HLA-mismatched allogeneic or myeloablative HCT received EPC before HCT admission with monthly or more frequent visits. Twenty-two (69%) of 32 subjects provided consent; 2 were later excluded (HCT cancelled, consent retracted) for a 63% participation rate. Comfort with EPC was high (82% very comfortable). Subjects reported stable or improved mood and sense of hope, without apparent negative effects with a median of 3 visits. Follow-up surveys were returned by 75% of participants at 60 days and by 65% at 90 days. Four (20%) were admitted to the intensive care unit before day 100 and 3 (15%) received life-support measures. Five (25%) died with median follow-up of 14 months. EPC is feasible, acceptable, and has the potential to improve the HCT experience, whether or not the patient survives. EPC for HCT patients should be tested in a randomized trial.

Authors
Loggers, ET; LeBlanc, TW; El-Jawahri, A; Fihn, J; Bumpus, M; David, J; Horak, P; Lee, SJ
MLA Citation
Loggers, ET, LeBlanc, TW, El-Jawahri, A, Fihn, J, Bumpus, M, David, J, Horak, P, and Lee, SJ. "Pretransplantation Supportive and Palliative Care Consultation for High-Risk Hematopoietic Cell Transplantation Patients." Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation 22.7 (July 2016): 1299-1305.
PMID
26976242
Source
epmc
Published In
Biology of Blood and Marrow Transplantation : Journal of the American Society for Blood and Marrow Transplantation
Volume
22
Issue
7
Publish Date
2016
Start Page
1299
End Page
1305
DOI
10.1016/j.bbmt.2016.03.006

Better Palliative Care for All: Improving the Lived Experience With Cancer.

Authors
Kamal, AH; LeBlanc, TW; Meier, DE
MLA Citation
Kamal, AH, LeBlanc, TW, and Meier, DE. "Better Palliative Care for All: Improving the Lived Experience With Cancer." JAMA 316.1 (July 2016): 29-30.
PMID
27244674
Source
epmc
Published In
Jama
Volume
316
Issue
1
Publish Date
2016
Start Page
29
End Page
30
DOI
10.1001/jama.2016.6491

Assessing Emotional Suffering in Palliative Care: Use of a Structured Note Template to Improve Documentation.

Documentation of the emotional or psychological needs of seriously ill patients receiving specialty palliative care is endorsed by the "Measuring What Matters" project as a quality performance metric and recommended for use by hospice and palliative care programs for program improvement.The aim of this study was to increase the proportion of inpatient palliative care team encounters in which emotional or psychological needs of patients and family members were documented and to qualitatively enrich the nature of this documentation.This is a mixed-methods retrospective study of 200 patient charts reviewed before and after implementation of a structured note template (SmartPhrase) for palliative care encounters. Patterns of documentation of emotional needs pre- and post-implementation were assessed quantitatively and qualitatively using thematic analysis.A total of 158 of 200 pre-intervention charts and 185 of 200 post-intervention charts included at least one note from the palliative care team. Documentation of emotional assessment increased after SmartPhrase implementation (63.9% [101 of 158] vs. 74.6% [138 of 185]; P < 0.03). Qualitative analysis revealed a post-intervention reduction in the use of generic phrases ("emotional support provided") and an increase in the breadth and depth of emotion-related documentation.A structured note template with a prompt for emotional assessment increases the overall quantity and richness of documentation related to patient and family emotions. However, this documentation remains mostly descriptive. Additional prompting for documentation of recommendations to address identified emotional needs, and the use of screening tools for depression and anxiety, when appropriate, may be necessary for clinically meaningful quality improvements in patient care.

Authors
Lamba, S; Berlin, A; Goett, R; Ponce, CB; Holland, B; Walther, S; AAHPM Research Committee Writing Group,
MLA Citation
Lamba, S, Berlin, A, Goett, R, Ponce, CB, Holland, B, Walther, S, and AAHPM Research Committee Writing Group, . "Assessing Emotional Suffering in Palliative Care: Use of a Structured Note Template to Improve Documentation." Journal of Pain and Symptom Management 52.1 (July 2016): 1-7.
PMID
27241439
Source
epmc
Published In
Journal of Pain and Symptom Management
Volume
52
Issue
1
Publish Date
2016
Start Page
1
End Page
7
DOI
10.1016/j.jpainsymman.2016.01.017

Potentially avoidable hospital admissions in older patients with acute myeloid leukaemia in the USA: a retrospective analysis.

Older adults (≥60 years of age) with acute myeloid leukaemia spend a substantial proportion of their life in hospital after diagnosis. We examined reasons for their hospital admissions and identified potentially avoidable hospital admissions (PAH) in this age group in the USA.In this retrospective analysis, we examined the reasons for hospital admissions in older patients diagnosed with and treated for acute myeloid leukaemia at two tertiary care hospitals in the USA. We included patients receiving intensive induction chemotherapy or non-intensive treatment. We excluded those with acute promyelocytic leukaemia, those seen only for a one-time consultation who received primary treatment elsewhere, and those who received supportive care alone. We identified the eligible cohort using the Dana-Farber Cancer Institute and Massachusetts General Hospital Leukemia Clinical Research Information Systems database. Practising oncologists used a consensus-driven medical record review process to identify the primary reason for each hospital admission and categorise it as potentially avoidable or not avoidable on the basis of an adaptation of Graham's criteria for PAH. We used multivariable logistic regression analyses to identify predictors of PAH.Between May 1, 2005, and Dec 23, 2011, we assessed 1040 hospital admissions (excluding initial admission for diagnosis) in 329 consecutively admitted patients. The most common primary reasons for hospital admissions were: fever or infection (396 [38%]), planned admission for chemotherapy or transplantation (391 [38%]), and uncontrolled symptoms (102 [10%]). We identified 172 (27%) of 649 unplanned hospital admissions as potentially avoidable; among these admissions, 82 (48%) were readmissions because of previous premature hospital discharge, 32 (19%) because of problems that could have been managed in the outpatient setting, and 26 (15%) because of failure of timely outpatient follow-up. In a mixed logistic regression model, higher education (odds ratio 1·43 [95% CI 1·01-2·00]; p=0·04) and receipt of non-intensive induction chemotherapy (1·97 [1·25-3·10]; p=0·003) were predictors of PAH.Although many hospital admissions in older patients with acute myeloid leukaemia are unavoidable and driven by the illness course and its treatment, a substantial proportion are potentially avoidable. Future interventions to reduce PAH in this population are clearly warranted.National Cancer Institute, National Palliative Care Research Center, and Cambia Health Foundation.

Authors
El-Jawahri, A; Keenan, T; Abel, GA; Steensma, DP; LeBlanc, TW; Chen, Y-B; Hobbs, G; Traeger, L; Fathi, AT; DeAngelo, DJ; Wadleigh, M; Ballen, KK; Amrein, PC; Stone, RM; Temel, JS
MLA Citation
El-Jawahri, A, Keenan, T, Abel, GA, Steensma, DP, LeBlanc, TW, Chen, Y-B, Hobbs, G, Traeger, L, Fathi, AT, DeAngelo, DJ, Wadleigh, M, Ballen, KK, Amrein, PC, Stone, RM, and Temel, JS. "Potentially avoidable hospital admissions in older patients with acute myeloid leukaemia in the USA: a retrospective analysis." The Lancet. Haematology 3.6 (June 2016): e276-e283.
PMID
27264037
Source
epmc
Published In
The Lancet Haematology
Volume
3
Issue
6
Publish Date
2016
Start Page
e276
End Page
e283
DOI
10.1016/s2352-3026(16)30024-2

Shared decision-making tools for patients with hematologic malignancies.

Authors
LeBlanc, TW; Rizzieri, D; Martin, P; Mayorga, V; Deering, K; Schenkel, B
MLA Citation
LeBlanc, TW, Rizzieri, D, Martin, P, Mayorga, V, Deering, K, and Schenkel, B. "Shared decision-making tools for patients with hematologic malignancies." Annual Meeting of the American-Society-of-Clinical-Oncology (ASCO). June 3, 2016 - June 7, 2016. Chicago, IL.: AMER SOC CLINICAL ONCOLOGY, May 20, 2016.
Source
wos
Published In
Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology
Volume
34
Issue
15
Publish Date
2016
DOI
10.1200/JCO.2016.34.15_suppl.e19007

Randomized trial of an inpatient palliative care intervention in patients hospitalized for hematopoietic stem cell transplantation (HCT).

Authors
El-Jawahri, A; LeBlanc, TW; Traeger, L; VanDusen, H; Jackson, VA; Greer, JA; Pirl, WF; Telles, J; Rhodes, A; Spitzer, TR; Chen, Y-BA; Lee, S; Temel, JS
MLA Citation
El-Jawahri, A, LeBlanc, TW, Traeger, L, VanDusen, H, Jackson, VA, Greer, JA, Pirl, WF, Telles, J, Rhodes, A, Spitzer, TR, Chen, Y-BA, Lee, S, and Temel, JS. "Randomized trial of an inpatient palliative care intervention in patients hospitalized for hematopoietic stem cell transplantation (HCT)." Annual Meeting of the American-Society-of-Clinical-Oncology (ASCO). June 3, 2016 - June 7, 2016. Chicago, IL.: AMER SOC CLINICAL ONCOLOGY, May 20, 2016.
Source
wos
Published In
Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology
Volume
34
Issue
15
Publish Date
2016
DOI
10.1200/JCO.2016.34.15_suppl.10004

Cancer patient experience with financial counseling among participants of an online registry.

Authors
Buzaglo, JS; Miller, MF; Karten, C; Longacre, M; LeBlanc, TW; Schapmire, TJ; Zafar, Y
MLA Citation
Buzaglo, JS, Miller, MF, Karten, C, Longacre, M, LeBlanc, TW, Schapmire, TJ, and Zafar, Y. "Cancer patient experience with financial counseling among participants of an online registry." Annual Meeting of the American-Society-of-Clinical-Oncology (ASCO). June 3, 2016 - June 7, 2016. Chicago, IL.: AMER SOC CLINICAL ONCOLOGY, May 20, 2016.
Source
wos
Published In
Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology
Volume
34
Issue
15
Publish Date
2016
DOI
10.1200/JCO.2016.34.15_suppl.e18265

A practical measurement of thoracic sarcopenia: correlation with clinical parameters and outcomes in advanced lung cancer.

Thoracic sarcopenia can feasibly be measured from routine CT scans but does not correlate to patient-centred outcomes http://ow.ly/102UkQ.

Authors
Wysham, NG; Nipp, RD; LeBlanc, TW; Wolf, SP; Ekstrom, MP; Currow, DC
MLA Citation
Wysham, NG, Nipp, RD, LeBlanc, TW, Wolf, SP, Ekstrom, MP, and Currow, DC. "A practical measurement of thoracic sarcopenia: correlation with clinical parameters and outcomes in advanced lung cancer." ERJ open research 2.2 (April 13, 2016). (letter)
Website
http://hdl.handle.net/10161/13059
PMID
27730193
Source
epmc
Published In
ERJ Open Research
Volume
2
Issue
2
Publish Date
2016
DOI
10.1183/23120541.00085-2015

An Exploratory Factor Analysis of the Scale Structure of the Patient Care Monitor Version 2.0.

The Patient Care Monitor (PCM), version 2.0, is an electronic patient-reported outcomes instrument designed to be embedded into oncology practices. One key psychometric component of an instrument is its factor structure.To validate the factor structure of the PCM.The PCM was administered within various oncology clinics at our institution from 2006 to 2011 as part of standard of care, yielding a large (n = 5624) and diverse data set. An exploratory factor analysis was performed.The PCM performed well in terms of missing values and floor and ceiling effects. The three scales postulated by the PCM developers exhibited high internal consistency (Cronbach alpha 0.94-0.95); the six subscales exhibited good internal consistency (Cronbach alpha 0.80-0.95). A three-factor model approximated simple structure and was consistent with the constructs of emotional function, physical function, and physical symptoms suggested by the PCM developers. However, a six-factor model did not support the division of these three constructs into subscales of despair, distress, ambulation, impaired performance, treatment side effects, and general physical symptoms. Instead, we observed an emotional factor, a physical functioning factor, a factor including many of the treatment side effects, and three factors consisting of various clusters of physical symptoms.Although six subscales postulated by its developers perform reasonably, allocation of the PCM items to three constructs is more accurate and likely more consistent with how symptoms and concerns are conceptualized by patients.

Authors
Samsa, GP; Wolf, S; LeBlanc, TW; Abernethy, AP
MLA Citation
Samsa, GP, Wolf, S, LeBlanc, TW, and Abernethy, AP. "An Exploratory Factor Analysis of the Scale Structure of the Patient Care Monitor Version 2.0." Journal of pain and symptom management 51.4 (April 2016): 776-783.e2.
PMID
26706623
Source
epmc
Published In
Journal of Pain and Symptom Management
Volume
51
Issue
4
Publish Date
2016
Start Page
776
End Page
783.e2
DOI
10.1016/j.jpainsymman.2015.11.013

Concordance of Advance Care Plans With Inpatient Directives in the Electronic Medical Record for Older Patients Admitted From the Emergency Department.

Measuring What Matters identified quality indicators to examine the percentage of patients with documentation of a surrogate decision maker and preferences for life-sustaining treatments.To determine the rate of advance care planning in older adults presenting to the emergency department (ED) and translation into medical directives in the electronic medical record (EMR).A convenience sample of adults 65 years or older was recruited from a large urban ED beginning in January 2012. We administered a baseline interview and survey in English or Spanish, including questions about whether patients had a documented health care proxy or living will. For patients admitted to the hospital who had a health care proxy or living will, chart abstraction was performed to determine whether their advance care preferences were documented in the EMR.From February 2012 to May 2013, 53.8% (367 of 682) of older adults who completed the survey in the ED reported having a health care proxy, and 40.2% (274 of 682) had a living will. Of those admitted to the hospital, only 4% (4 of 94) of patients who said they had a living will had medical directives documented in the EMR. Similarly, only 4% (5 of 115) of patients who had a health care proxy had the person's name or contact information documented in their medical record.About half of the patients 65 years or older arriving in the ED have done significant advance care planning, but most plans are not recorded in the EMR.

Authors
Grudzen, CR; Buonocore, P; Steinberg, J; Ortiz, JM; Richardson, LD; AAHPM Research Committee Writing Group,
MLA Citation
Grudzen, CR, Buonocore, P, Steinberg, J, Ortiz, JM, Richardson, LD, and AAHPM Research Committee Writing Group, . "Concordance of Advance Care Plans With Inpatient Directives in the Electronic Medical Record for Older Patients Admitted From the Emergency Department." Journal of Pain and Symptom Management 51.4 (April 2016): 647-651.
PMID
26891604
Source
epmc
Published In
Journal of Pain and Symptom Management
Volume
51
Issue
4
Publish Date
2016
Start Page
647
End Page
651
DOI
10.1016/j.jpainsymman.2015.12.318

Association of high rates of practice-level inpatient-intensity with end-of-life outcomes, readmission rates, and weekend hospitalizations among Medicare patients with cancer

Authors
Clough, JD; Strawbridge, LM; LeBlanc, TW; Hammill, BG; Kamal, A
MLA Citation
Clough, JD, Strawbridge, LM, LeBlanc, TW, Hammill, BG, and Kamal, A. "Association of high rates of practice-level inpatient-intensity with end-of-life outcomes, readmission rates, and weekend hospitalizations among Medicare patients with cancer." March 1, 2016.
Source
wos-lite
Published In
Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology
Volume
34
Issue
7
Publish Date
2016

Adherence to Measuring What Matters Measures Using Point-of-Care Data Collection Across Diverse Clinical Settings.

Measuring What Matters (MWM) for palliative care has prioritized data collection efforts for evaluating quality in clinical practice. How these measures can be implemented across diverse clinical settings using point-of-care data collection on quality is unknown.To evaluate the implementation of MWM measures by exploring documentation of quality measure adherence across six diverse clinical settings inherent to palliative care practice.We deployed a point-of-care quality data collection system, the Quality Data Collection Tool, across five organizations within the Palliative Care Research Cooperative Group. Quality measures were recorded by clinicians or assistants near care delivery.During the study period, 1989 first visits were included for analysis. Our population was mostly white, female, and with moderate performance status. About half of consultations were seen on hospital general floors. We observed a wide range of adherence. The lowest adherence involved comprehensive assessments during the first visit in hospitalized patients in the intensive care unit (2.71%); the highest adherence across all settings, with an implementation of >95%, involved documentation of management of moderate/severe pain. We observed differences in adherence across clinical settings especially with MWM Measure #2 (Screening for Physical Symptoms, range 45.7%-81.8%); MWM Measure #5 (Discussion of Emotional Needs, range 46.1%-96.1%); and MWM Measure #6 (Documentation of Spiritual/Religious Concerns, range 0-69.6%).Variations in clinician documentation of adherence to MWM quality measures are seen across clinical settings. Additional studies are needed to better understand benchmarks and acceptable ranges for adherence tailored to various clinical settings.

Authors
Kamal, AH; Bull, J; Ritchie, CS; Kutner, JS; Hanson, LC; Friedman, F; Taylor, DH; AAHPM Research Committee Writing Group,
MLA Citation
Kamal, AH, Bull, J, Ritchie, CS, Kutner, JS, Hanson, LC, Friedman, F, Taylor, DH, and AAHPM Research Committee Writing Group, . "Adherence to Measuring What Matters Measures Using Point-of-Care Data Collection Across Diverse Clinical Settings." Journal of Pain and Symptom Management 51.3 (March 2016): 497-503.
PMID
26854995
Source
epmc
Published In
Journal of Pain and Symptom Management
Volume
51
Issue
3
Publish Date
2016
Start Page
497
End Page
503
DOI
10.1016/j.jpainsymman.2015.12.313

Clinical and Immunomodulatiory Outcomes of Microtransplantation for AML

Authors
Rizzieri, DA; Rao, AV; Beaven, A; Brander, D; DeCastro, C; Diehl, L; LeBlanc, TW; Long, GD; McKinney, M; Toaso, B; Chao, NJ; Sung, AD
MLA Citation
Rizzieri, DA, Rao, AV, Beaven, A, Brander, D, DeCastro, C, Diehl, L, LeBlanc, TW, Long, GD, McKinney, M, Toaso, B, Chao, NJ, and Sung, AD. "Clinical and Immunomodulatiory Outcomes of Microtransplantation for AML." March 2016.
Source
crossref
Published In
Biology of Blood and Marrow Transplantation : Journal of the American Society for Blood and Marrow Transplantation
Volume
22
Issue
3
Publish Date
2016
Start Page
S207
End Page
S208
DOI
10.1016/j.bbmt.2015.11.602

Breakthrough cancer pain

Authors
LeBlanc, TW; Howie, LJ; Abernethy, AP
MLA Citation
LeBlanc, TW, Howie, LJ, and Abernethy, AP. "Breakthrough cancer pain." Supportive Cancer Care. February 2, 2016. 127-137.
Source
scopus
Publish Date
2016
Start Page
127
End Page
137
DOI
10.1007/978-3-319-24814-1_8

Addressing End-of-Life Quality Gaps in Hematologic Cancers: The Importance of Early Concurrent Palliative Care.

Authors
LeBlanc, TW
MLA Citation
LeBlanc, TW. "Addressing End-of-Life Quality Gaps in Hematologic Cancers: The Importance of Early Concurrent Palliative Care." Jama Internal Medicine 176.2 (February 2016): 265-266.
PMID
26720324
Source
epmc
Published In
Jama Internal Medicine
Volume
176
Issue
2
Publish Date
2016
Start Page
265
End Page
266
DOI
10.1001/jamainternmed.2015.6994

Feeling Heard and Understood: A Patient-Reported Quality Measure for the Inpatient Palliative Care Setting.

As endorsed by the palliative care "Measuring What Matters" initiative, capturing patients' direct assessment of their care is essential for ongoing quality reporting and improvement. Fostering an environment where seriously ill patients feel heard and understood is of crucial importance to modern health care.To describe the development and performance of a self-report field measure for seriously ill patients to report how well they feel heard and understood in the hospital environment.As part of a larger ongoing cohort study of inpatient palliative care, we developed and administered the following point-of-care item: "Over the past two days, how much have you felt heard and understood by the doctors, nurses and hospital staff?" (completely, quite a bit, moderately, slightly, not at all). Participants completed the measure before and the day after palliative care consultation. For the postconsultation version, we changed the time frame from "past two days" to "today."One hundred sixty patients with advanced cancer completed the preconsultation assessment, and 87% of them completed the postconsultation version. Responses encompassed full use of the ordinal scale, did not exhibit ceiling or floor effects, and showed improvement from preassessment to postassessment. The item was quick to administer and easy for patients to complete.The "Heard & Understood" item is a promising self-report quality measure for the inpatient palliative care setting.

Authors
Gramling, R; Stanek, S; Ladwig, S; Gajary-Coots, E; Cimino, J; Anderson, W; Norton, SA; AAHPM Research Committee Writing Group, ; Aslakson, RA; Ast, K; Elk, R; Garner, KK; Grudzen, C; Kamal, AH; Lamba, S; LeBlanc, TW; Rhodes, RL; Roeland, E; Schulman-Green, D; Unroe, KT
MLA Citation
Gramling, R, Stanek, S, Ladwig, S, Gajary-Coots, E, Cimino, J, Anderson, W, Norton, SA, AAHPM Research Committee Writing Group, , Aslakson, RA, Ast, K, Elk, R, Garner, KK, Grudzen, C, Kamal, AH, Lamba, S, LeBlanc, TW, Rhodes, RL, Roeland, E, Schulman-Green, D, and Unroe, KT. "Feeling Heard and Understood: A Patient-Reported Quality Measure for the Inpatient Palliative Care Setting." Journal of Pain and Symptom Management 51.2 (February 2016): 150-154.
PMID
26596879
Source
epmc
Published In
Journal of Pain and Symptom Management
Volume
51
Issue
2
Publish Date
2016
Start Page
150
End Page
154
DOI
10.1016/j.jpainsymman.2015.10.018

Persuasive Proposal Development 101: How to Convince Others to Fund Your Program, Your Research, or Your Clinical Initiatives (FR480)

Authors
Harrison, K; Furuno, J; LeBlanc, T; Kamal, A; Ferrell, B
MLA Citation
Harrison, K, Furuno, J, LeBlanc, T, Kamal, A, and Ferrell, B. "Persuasive Proposal Development 101: How to Convince Others to Fund Your Program, Your Research, or Your Clinical Initiatives (FR480)." February 2016.
Source
crossref
Published In
Journal of Pain and Symptom Management
Volume
51
Issue
2
Publish Date
2016
Start Page
378
End Page
379
DOI
10.1016/j.jpainsymman.2015.12.249

Using the Distress Thermometer to Highlight Palliative Care Needs of Patients with Acute Myeloid Leukemia (AML) (TH361B)

Authors
LeBlanc, T; El-Jawahri, A; Tulsky, J; Abernethy, A
MLA Citation
LeBlanc, T, El-Jawahri, A, Tulsky, J, and Abernethy, A. "Using the Distress Thermometer to Highlight Palliative Care Needs of Patients with Acute Myeloid Leukemia (AML) (TH361B)." February 2016.
Source
crossref
Published In
Journal of Pain and Symptom Management
Volume
51
Issue
2
Publish Date
2016
Start Page
343
End Page
344
DOI
10.1016/j.jpainsymman.2015.12.179

Palliative chemotherapy: oxymoron or misunderstanding?

Oncologists routinely prescribe chemotherapy for patients with advanced cancer. This practice is sometimes misunderstood by palliative care clinicians, yet data clearly show that chemotherapy can be a powerful palliative intervention when applied appropriately. Clarity regarding the term "palliative chemotherapy" is needed: it is chemotherapy given in the non-curative setting to optimize symptom control, improve quality of life, and sometimes to improve survival. Unfortunately, oncologists lack adequate tools to predict which patients will benefit. In a study recently published in BMC Palliative Care, Creutzfeldt et al. presented an innovative approach to advancing the science in this area: using patient reported outcomes to predict responses to palliative chemotherapy. With further research, investigators may be able to develop predictive models for use at the bedside to inform clinical decision-making about the risks and benefits of treatment. In the meantime, oncologists and palliative care clinicians must work together to reduce the use of "end-of-life chemotherapy"-chemotherapy given close to death, which does not improve longevity or symptom control-while optimizing the use of chemotherapy that has true palliative benefits for patients.

Authors
Roeland, EJ; LeBlanc, TW
MLA Citation
Roeland, EJ, and LeBlanc, TW. "Palliative chemotherapy: oxymoron or misunderstanding?." Bmc Palliative Care 15 (January 2016): 33-null.
Website
http://hdl.handle.net/10161/13829
PMID
27000049
Source
epmc
Published In
Bmc Palliative Care
Volume
15
Publish Date
2016
Start Page
33
DOI
10.1186/s12904-016-0109-4

Discussing the Evidence for Upstream Palliative Care in Improving Outcomes in Advanced Cancer.

Palliative care has received increasing attention at the American Society of Clinical Oncology (ASCO) Annual Meeting since the publication of its provisional clinical opinion on the topic in 2012. Despite frequent discussion, palliative care remains a source of some controversy and confusion in clinical practice, especially concerning who should provide it, what it encompasses, and when and how it can help patients and their families. In this article, we provide a formal definition of palliative care and review the state of the science of palliative care in oncology. Several randomized controlled trials now show that palliative care improves important outcomes for patients with cancer. Related outcome improvements include a reduction in symptoms, improved quality of life, better prognostic understanding, less depressed mood, less aggressive end-of-life care, reduced resource utilization, and even prolonged survival. As such, ASCO recommends early integration of palliative care into comprehensive cancer care for all patients with advanced disease and/or significant symptom burden. Our aim is that this summary will facilitate greater understanding about palliative care and encourage further integration of palliative care services into cancer care. More research is needed to illuminate the mechanisms of action of palliative care and to improve the specificity of palliative care applications to unique scenarios and populations in oncology.

Authors
Nickolich, MS; El-Jawahri, A; Temel, JS; LeBlanc, TW
MLA Citation
Nickolich, MS, El-Jawahri, A, Temel, JS, and LeBlanc, TW. "Discussing the Evidence for Upstream Palliative Care in Improving Outcomes in Advanced Cancer." American Society of Clinical Oncology Educational Book. American Society of Clinical Oncology. Annual Meeting 35 (January 2016): e534-e538.
PMID
27249764
Source
epmc
Published In
American Society of Clinical Oncology Educational Book. American Society of Clinical Oncology. Meeting
Volume
35
Publish Date
2016
Start Page
e534
End Page
e538
DOI
10.1200/edbk_159224

Multiple Myeloma Patient Experience with Financial Toxicity: Findings from the Cancer Experience Registry

Authors
Buzaglo, JS; Miller, MF; Karten, C; Longacre, M; Kennedy, V; LeBlanc, TW
MLA Citation
Buzaglo, JS, Miller, MF, Karten, C, Longacre, M, Kennedy, V, and LeBlanc, TW. "Multiple Myeloma Patient Experience with Financial Toxicity: Findings from the Cancer Experience Registry." 57th Annual Meeting of the American-Society-of-Hematology. December 5, 2015 - December 8, 2015. Orlando, FL.: AMER SOC HEMATOLOGY, December 3, 2015.
Source
wos
Published In
Blood
Volume
126
Issue
23
Publish Date
2015

Potentially Avoidable Hospitalizations in Older Patients with Acute Myeloid Leukemia (AML)

Authors
El-Jawahri, A; Keenan, T; Abel, G; Steensma, DP; LeBlanc, TW; Traeger, L; Fathi, AT; DeAngelo, DJ; Wadleigh, M; Hobbs, G; Amrein, PC; Stone, RM; Ballen, KK; Chen, Y-B; Temel, JS
MLA Citation
El-Jawahri, A, Keenan, T, Abel, G, Steensma, DP, LeBlanc, TW, Traeger, L, Fathi, AT, DeAngelo, DJ, Wadleigh, M, Hobbs, G, Amrein, PC, Stone, RM, Ballen, KK, Chen, Y-B, and Temel, JS. "Potentially Avoidable Hospitalizations in Older Patients with Acute Myeloid Leukemia (AML)." 57th Annual Meeting of the American-Society-of-Hematology. December 5, 2015 - December 8, 2015. Orlando, FL.: AMER SOC HEMATOLOGY, December 3, 2015.
Source
wos
Published In
Blood
Volume
126
Issue
23
Publish Date
2015

Development of an Online Patient Decision Aid for Previously Treated Mantle Cell Lymphoma

Authors
LeBlanc, TW; Wolf, RC; Neylon, E; Caroselli, V; Deering, K; Schenkel, B
MLA Citation
LeBlanc, TW, Wolf, RC, Neylon, E, Caroselli, V, Deering, K, and Schenkel, B. "Development of an Online Patient Decision Aid for Previously Treated Mantle Cell Lymphoma." 57th Annual Meeting of the American-Society-of-Hematology. December 5, 2015 - December 8, 2015. Orlando, FL.: AMER SOC HEMATOLOGY, December 3, 2015.
Source
wos
Published In
Blood
Volume
126
Issue
23
Publish Date
2015

Symptom Burden, Quality of Life, and Distress in Acute Myeloid Leukemia Patients Receiving Induction Chemotherapy: Results of a Prospective Electronic Patient-Reported Outcomes Study

Authors
LeBlanc, TW; Wolf, SP; El-Jawahri, A; Davis, DM; Locke, SC; Abernethy, A
MLA Citation
LeBlanc, TW, Wolf, SP, El-Jawahri, A, Davis, DM, Locke, SC, and Abernethy, A. "Symptom Burden, Quality of Life, and Distress in Acute Myeloid Leukemia Patients Receiving Induction Chemotherapy: Results of a Prospective Electronic Patient-Reported Outcomes Study." 57th Annual Meeting of the American-Society-of-Hematology. December 5, 2015 - December 8, 2015. Orlando, FL.: AMER SOC HEMATOLOGY, December 3, 2015.
Source
wos
Published In
Blood
Volume
126
Issue
23
Publish Date
2015

Outcomes for Older Patients with Acute Myeloid Leukemia Admitted to the Intensive Care Unit

Authors
Keenan, T; LeBlanc, TW; Traeger, L; Vandusen, H; Abel, GA; Steensma, DP; Fathi, AT; DeAngelo, DJ; Wadleigh, M; Hobbs, G; Amrein, PC; Stone, RM; Ballen, KK; Chen, Y-B; Temel, JS; El-Jawahri, A
MLA Citation
Keenan, T, LeBlanc, TW, Traeger, L, Vandusen, H, Abel, GA, Steensma, DP, Fathi, AT, DeAngelo, DJ, Wadleigh, M, Hobbs, G, Amrein, PC, Stone, RM, Ballen, KK, Chen, Y-B, Temel, JS, and El-Jawahri, A. "Outcomes for Older Patients with Acute Myeloid Leukemia Admitted to the Intensive Care Unit." 57th Annual Meeting of the American-Society-of-Hematology. December 5, 2015 - December 8, 2015. Orlando, FL.: AMER SOC HEMATOLOGY, December 3, 2015.
Source
wos
Published In
Blood
Volume
126
Issue
23
Publish Date
2015

Health Care Utilization and End of Life Care for Older Patients with Acute Myeloid Leukemia Receiving Supportive Care Alone

Authors
El-Jawahri, A; Heavey, SF; LeBlanc, TW; Vandusen, H; Abel, G; Steensma, DP; Traeger, L; Fathi, AT; DeAngelo, DJ; Wadleigh, M; Hobbs, G; Amrein, PC; Stone, RM; Ballen, KK; Chen, Y-B; Temel, JS
MLA Citation
El-Jawahri, A, Heavey, SF, LeBlanc, TW, Vandusen, H, Abel, G, Steensma, DP, Traeger, L, Fathi, AT, DeAngelo, DJ, Wadleigh, M, Hobbs, G, Amrein, PC, Stone, RM, Ballen, KK, Chen, Y-B, and Temel, JS. "Health Care Utilization and End of Life Care for Older Patients with Acute Myeloid Leukemia Receiving Supportive Care Alone." 57th Annual Meeting of the American-Society-of-Hematology. December 5, 2015 - December 8, 2015. Orlando, FL.: AMER SOC HEMATOLOGY, December 3, 2015.
Source
wos
Published In
Blood
Volume
126
Issue
23
Publish Date
2015

What bothers lung cancer patients the most? A prospective, longitudinal electronic patient-reported outcomes study in advanced non-small cell lung cancer.

Patients with advanced non-small cell lung cancer (aNSCLC) face a significant symptom burden. Little is known about the frequency and severity of symptoms over time, so we longitudinally characterized patients' symptoms using the Patient Care Monitor (PCM) version 2.0, an electronic symptom-assessment tool.Ninety-seven patients with aNSCLC completed the PCM at up to four clinic visits. We analyzed symptom data by incidence, severity, type (functional vs. nonfunctional), proximity to death, and cancer anorexia-cachexia syndrome status (CACS).Functional concerns predominated, even in the non-CACS group. Average severity among the top 5 symptoms was worse for functional than nonfunctional items (mean difference 0.62, 95% CI 0.22-1.01, P = 0.003). Severe dyspnea and fatigue were the most prevalent nonfunctional symptoms; moderate/severe dyspnea was reported by at least 29% of patients, and fatigue by over 50%. Depression was reported infrequently, with over half of patients at each visit reporting "none"; moderate or severe depression was reported in only 2.5-9.3 and 3.4-6.2% of patients, respectively. The average number of moderate/severe symptoms increased with proximity to death; 84% reported moderate/severe fatigue in the last 3 months of life, compared to 48% at ≥ 12 months from death (P = 0.007).Patients with aNSCLC face a significant symptom burden, which increases with proximity to death. Symptom type and severity vary by proximity to death, but even patients without overt CACS report significant functional symptoms throughout. We recommend an individualized approach to palliative symptom intervention in advanced lung cancer, based on detailed symptom assessment and tracking.

Authors
LeBlanc, TW; Nickolich, M; Rushing, CN; Samsa, GP; Locke, SC; Abernethy, AP
MLA Citation
LeBlanc, TW, Nickolich, M, Rushing, CN, Samsa, GP, Locke, SC, and Abernethy, AP. "What bothers lung cancer patients the most? A prospective, longitudinal electronic patient-reported outcomes study in advanced non-small cell lung cancer." Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer 23.12 (December 2015): 3455-3463.
PMID
25791391
Source
epmc
Published In
Supportive Care in Cancer : Official Journal of the Multinational Association of Supportive Care in Cancer
Volume
23
Issue
12
Publish Date
2015
Start Page
3455
End Page
3463
DOI
10.1007/s00520-015-2699-4

Pruritus as an unmet palliative care need in cancer patients: A retrospective cohort study of a Duke patient-reported outcomes database.

Authors
Hudson, KE; Wolf, SP; Pupa, MR; King, DG; Locke, SC; Abernethy, AP; LeBlanc, TW
MLA Citation
Hudson, KE, Wolf, SP, Pupa, MR, King, DG, Locke, SC, Abernethy, AP, and LeBlanc, TW. "Pruritus as an unmet palliative care need in cancer patients: A retrospective cohort study of a Duke patient-reported outcomes database." October 10, 2015.
Source
crossref
Published In
Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology
Volume
33
Issue
29_suppl
Publish Date
2015
Start Page
97
End Page
97
DOI
10.1200/jco.2015.33.29_suppl.97

Fatigue in long-term non-Hodgkin lymphoma survivors.

Authors
Hudson, KE; Benecha, HK; Houck, KL; LeBlanc, TW; Abernethy, AP; Zimmerman, S; Ganz, PA; Smith, SK
MLA Citation
Hudson, KE, Benecha, HK, Houck, KL, LeBlanc, TW, Abernethy, AP, Zimmerman, S, Ganz, PA, and Smith, SK. "Fatigue in long-term non-Hodgkin lymphoma survivors.": American Society of Clinical Oncology (ASCO), October 10, 2015.
Source
crossref
Published In
Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology
Volume
33
Issue
29_suppl
Publish Date
2015
Start Page
239
End Page
239
DOI
10.1200/jco.2015.33.29_suppl.239

Severity of and contributors to distress in patients with acute myeloid leukemia (AML) receiving induction chemotherapy.

Authors
LeBlanc, TW; Wolf, SP; Davis, DM; Samsa, G; Locke, SC; El-Jawahri, A; Tulsky, JA; Abernethy, AP
MLA Citation
LeBlanc, TW, Wolf, SP, Davis, DM, Samsa, G, Locke, SC, El-Jawahri, A, Tulsky, JA, and Abernethy, AP. "Severity of and contributors to distress in patients with acute myeloid leukemia (AML) receiving induction chemotherapy." October 10, 2015.
Source
crossref
Published In
Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology
Volume
33
Issue
29_suppl
Publish Date
2015
Start Page
83
End Page
83
DOI
10.1200/jco.2015.33.29_suppl.83

Symptom burden and palliative care for patients with multiple myeloma: Cancer Experience Registry findings.

Authors
Buzaglo, JS; Miller, MF; Karten, C; Longacre, M; LeBlanc, TW
MLA Citation
Buzaglo, JS, Miller, MF, Karten, C, Longacre, M, and LeBlanc, TW. "Symptom burden and palliative care for patients with multiple myeloma: Cancer Experience Registry findings." October 10, 2015.
Source
crossref
Published In
Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology
Volume
33
Issue
29_suppl
Publish Date
2015
Start Page
81
End Page
81
DOI
10.1200/jco.2015.33.29_suppl.81

Potentially avoidable hospitalizations in older patients with acute myeloid leukemia (AML).

Authors
El-Jawahri, A; Keenan, T; Abel, GA; Steensma, DP; LeBlanc, TW; Traeger, L; Fathi, AT; DeAngelo, DJ; Wadleigh, M; Hobbs, G; Amrein, PC; Stone, RM; Ballen, KK; Chen, Y-BA; Temel, JS
MLA Citation
El-Jawahri, A, Keenan, T, Abel, GA, Steensma, DP, LeBlanc, TW, Traeger, L, Fathi, AT, DeAngelo, DJ, Wadleigh, M, Hobbs, G, Amrein, PC, Stone, RM, Ballen, KK, Chen, Y-BA, and Temel, JS. "Potentially avoidable hospitalizations in older patients with acute myeloid leukemia (AML)." October 10, 2015.
Source
crossref
Published In
Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology
Volume
33
Issue
29_suppl
Publish Date
2015
Start Page
206
End Page
206
DOI
10.1200/jco.2015.33.29_suppl.206

Chemotherapy Use, Performance Status, and Quality of Life at the End of Life.

Although many patients with end-stage cancer are offered chemotherapy to improve quality of life (QOL), the association between chemotherapy and QOL amid progressive metastatic disease has not been well-studied. American Society for Clinical Oncology guidelines recommend palliative chemotherapy only for solid tumor patients with good performance status.To evaluate the association between chemotherapy use and QOL near death (QOD) as a function of patients' performance status.A multi-institutional, longitudinal cohort study of patients with end-stage cancer recruited between September 2002 and February 2008. Chemotherapy use (n = 158 [50.6%]) and Eastern Cooperative Oncology Group (ECOG) performance status were assessed at baseline (median = 3.8 months before death) and patients with progressive metastatic cancer (N = 312) following at least 1 chemotherapy regimen were followed prospectively until death at 6 outpatient oncology clinics in the United States.Patient QOD was determined using validated caregiver ratings of patients' physical and mental distress in their final week.Chemotherapy use was not associated with patient survival controlling for clinical setting and patients' performance status. Among patients with good (ECOG score = 1) baseline performance status, chemotherapy use compared with nonuse was associated with worse QOD (odds ratio [OR], 0.35; 95% CI, 0.17-0.75; P = .01). Baseline chemotherapy use was not associated with QOD among patients with moderate (ECOG score = 2) baseline performance status (OR, 1.06; 95% CI, 0.51-2.21; P = .87) or poor (ECOG score = 3) baseline performance status (OR, 1.34; 95% CI, 0.46-3.89; P = .59).Although palliative chemotherapy is used to improve QOL for patients with end-stage cancer, its use did not improve QOD for patients with moderate or poor performance status and worsened QOD for patients with good performance status. The QOD in patients with end-stage cancer is not improved, and can be harmed, by chemotherapy use near death, even in patients with good performance status.

Authors
Prigerson, HG; Bao, Y; Shah, MA; Paulk, ME; LeBlanc, TW; Schneider, BJ; Garrido, MM; Reid, MC; Berlin, DA; Adelson, KB; Neugut, AI; Maciejewski, PK
MLA Citation
Prigerson, HG, Bao, Y, Shah, MA, Paulk, ME, LeBlanc, TW, Schneider, BJ, Garrido, MM, Reid, MC, Berlin, DA, Adelson, KB, Neugut, AI, and Maciejewski, PK. "Chemotherapy Use, Performance Status, and Quality of Life at the End of Life." Jama Oncology 1.6 (September 2015): 778-784.
PMID
26203912
Source
epmc
Published In
Jama Oncology
Volume
1
Issue
6
Publish Date
2015
Start Page
778
End Page
784
DOI
10.1001/jamaoncol.2015.2378

Validation and real-world assessment of the Functional Assessment of Anorexia-Cachexia Therapy (FAACT) scale in patients with advanced non-small cell lung cancer and the cancer anorexia-cachexia syndrome (CACS).

Patients with cancer anorexia-cachexia syndrome (CACS) suffer a significant symptom burden, impaired quality of life (QoL), and shorter survival. Measurement of QoL impairments related to CACS is thereby important both in clinical practice and in research. We aimed to further validate the Functional Assessment of Anorexia-Cachexia Therapy (FAACT) scale in an advanced lung cancer population.We tested the performance of the FAACT and its anorexia-cachexia subscale (ACS) within a dataset of patients with advanced non-small cell lung cancer (aNSCLC), using standard statistical methods. We then compared the performance of commonly used QoL measures stratified by CACS status and by patient self-report of appetite and weight loss.The FAACT and its ACS demonstrate internal validity consistent with acceptable published ranges for other QoL scales (Cronbach alpha = 0.9 and 0.79, respectively). Correlation coefficients demonstrate moderate correlations in the expected directions between FAACT and ACS and scales that measure related constructs. Comparing patients with and without CACS, the ACS is more sensitive to change than other QoL instruments (mean score 33.1 vs. 37.2, p = 0.011, ES = 0.58).In patients with aNSCLC, the FAACT and its ACS performed well compared with other instruments, further supporting their validity and value in clinical research. FAACT and ACS scores covaried with symptoms and other QoL changes that are typical hallmarks of CACS, lending further support to their use as QoL endpoints in clinical trials among patients with CACS.

Authors
LeBlanc, TW; Samsa, GP; Wolf, SP; Locke, SC; Cella, DF; Abernethy, AP
MLA Citation
LeBlanc, TW, Samsa, GP, Wolf, SP, Locke, SC, Cella, DF, and Abernethy, AP. "Validation and real-world assessment of the Functional Assessment of Anorexia-Cachexia Therapy (FAACT) scale in patients with advanced non-small cell lung cancer and the cancer anorexia-cachexia syndrome (CACS)." Supportive Care in Cancer : Official Journal of the Multinational Association of Supportive Care in Cancer 23.8 (August 2015): 2341-2347.
PMID
25586527
Source
epmc
Published In
Supportive Care in Cancer : Official Journal of the Multinational Association of Supportive Care in Cancer
Volume
23
Issue
8
Publish Date
2015
Start Page
2341
End Page
2347
DOI
10.1007/s00520-015-2606-z

Health care utilization and end-of-life care for older patients with acute myeloid leukemia.

Health care utilization in older adults (age ≥60 years) with acute myeloid leukemia (AML) has not been well studied.We conducted a retrospective analysis of 330 consecutive older patients who were diagnosed with AML between May 1, 2005 and December 23, 2011, at 2 hospitals in Boston to examine their health care utilization and end-of-life care. Using multivariable logistic and linear regression models adjusting for covariates, we also compared health care utilization between patients who received intensive induction chemotherapy (n = 197; cytarabine/ anthracycline combination) versus nonintensive chemotherapy (n = 133; single-agent therapy).The median number of hospitalizations for the entire cohort was 4.2 (range, 1-18 hospitalizations). Patients who died spent a mean of 28.3% of their life after diagnosis in the hospital and 13.8% of their life attending outpatient clinic appointments. Although the majority of patients (87.9%) died during the 2-year follow-up period, a minority received palliative care (16.2%) or hospice (23.1%) services. Within 30 days of death, 84.5% of patients were hospitalized, and 61% died in the hospital. Among the patients who died, those who received intensive induction therapy (vs nonintensive therapy) spent 30% more of their life after diagnosis in the hospital (P < .0001) and were less likely to receive hospice services (odds ratio, 0.45; P = .05).The current findings highlight the intensity of health care utilization among older patients with AML, regardless of treatment modality. Despite the poor prognosis, palliative care and hospice services are rarely used. Future work should study novel health care delivery models to optimize care throughout the course of illness and at the end of life.

Authors
El-Jawahri, AR; Abel, GA; Steensma, DP; LeBlanc, TW; Fathi, AT; Graubert, TA; DeAngelo, DJ; Wadleigh, M; Ballen, KK; Foster, JE; Attar, EC; Amrein, PC; Brunner, AM; Stone, RM; Temel, JS
MLA Citation
El-Jawahri, AR, Abel, GA, Steensma, DP, LeBlanc, TW, Fathi, AT, Graubert, TA, DeAngelo, DJ, Wadleigh, M, Ballen, KK, Foster, JE, Attar, EC, Amrein, PC, Brunner, AM, Stone, RM, and Temel, JS. "Health care utilization and end-of-life care for older patients with acute myeloid leukemia." Cancer 121.16 (August 2015): 2840-2848.
PMID
25926135
Source
epmc
Published In
Cancer
Volume
121
Issue
16
Publish Date
2015
Start Page
2840
End Page
2848
DOI
10.1002/cncr.29430

Symptom burden of haematological malignancies as death approaches in a community palliative care service: a retrospective cohort study of a consecutive case series.

Patients with haematological malignancies are less likely to use palliative care services than are patients with solid tumours. This difference might stem from differing symptom burden, care needs, disease trajectories, or a combination of these factors. We described symptom burden and physical decline over time for people with haematological malignancies compared with people with solid tumours in a consecutive case series.We included patients admitted to Silver Chain Hospice Care Service who died between Jan 1, 2011, and Dec 31, 2013, and who completed the eight-item Symptom Assessment Scale (0-10, with 0=no distress and 10=worst distress) at each clinical encounter. Physical function was assessed with the Australia-modified Karnofsky performance scale. Symptom and functional assessments were analysed at 7 days, 30 days, 60 days, and 90 days before death, by descriptive statistics.We included 4638 participants. For people with haematological malignancies (n=224), the most troublesome symptoms were fatigue (mean score 5·2, SD 2·7) and loss of appetite (2·3, SD 2·9), and both worsened significantly near death (p=0·0035 for fatigue, p=0·016 for appetite). Other symptoms were often absent, and changed little over time. Compared with patients with solid tumours (n=4414), there were no significant differences in individual or cumulative symptom scores, changes over time, or the pattern of functional decline.Community patients with haematological malignancies receiving palliative care have similar symptoms and patterns of physical decline at the end of life to people with solid tumours, suggesting similar care needs. This finding questions present limited palliative care service use by patients with haematological malignancies.None.

Authors
LeBlanc, TW; Smith, JM; Currow, DC
MLA Citation
LeBlanc, TW, Smith, JM, and Currow, DC. "Symptom burden of haematological malignancies as death approaches in a community palliative care service: a retrospective cohort study of a consecutive case series." The Lancet. Haematology 2.8 (August 2015): e334-e338.
PMID
26688486
Source
epmc
Published In
The Lancet Haematology
Volume
2
Issue
8
Publish Date
2015
Start Page
e334
End Page
e338
DOI
10.1016/s2352-3026(15)00111-8

Cancer-Related Fatigue, Version 2.2015.

Cancer-related fatigue is defined as a distressing, persistent, subjective sense of physical, emotional, and/or cognitive tiredness or exhaustion related to cancer or cancer treatment that is not proportional to recent activity and interferes with usual functioning. It is one of the most common side effects in patients with cancer. Fatigue has been shown to be a consequence of active treatment, but it may also persist into posttreatment periods. Furthermore, difficulties in end-of-life care can be compounded by fatigue. The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Cancer-Related Fatigue provide guidance on screening for fatigue and recommendations for interventions based on the stage of treatment. Interventions may include education and counseling, general strategies for the management of fatigue, and specific nonpharmacologic and pharmacologic interventions. Fatigue is a frequently underreported complication in patients with cancer and, when reported, is responsible for reduced quality of life. Therefore, routine screening to identify fatigue is an important component in improving the quality of life for patients living with cancer.

Authors
Berger, AM; Mooney, K; Alvarez-Perez, A; Breitbart, WS; Carpenter, KM; Cella, D; Cleeland, C; Dotan, E; Eisenberger, MA; Escalante, CP; Jacobsen, PB; Jankowski, C; LeBlanc, T; Ligibel, JA; Loggers, ET; Mandrell, B; Murphy, BA; Palesh, O; Pirl, WF; Plaxe, SC; Riba, MB; Rugo, HS; Salvador, C; Wagner, LI; Wagner-Johnston, ND; Zachariah, FJ; Bergman, MA; Smith, C; National comprehensive cancer network,
MLA Citation
Berger, AM, Mooney, K, Alvarez-Perez, A, Breitbart, WS, Carpenter, KM, Cella, D, Cleeland, C, Dotan, E, Eisenberger, MA, Escalante, CP, Jacobsen, PB, Jankowski, C, LeBlanc, T, Ligibel, JA, Loggers, ET, Mandrell, B, Murphy, BA, Palesh, O, Pirl, WF, Plaxe, SC, Riba, MB, Rugo, HS, Salvador, C, Wagner, LI, Wagner-Johnston, ND, Zachariah, FJ, Bergman, MA, Smith, C, and National comprehensive cancer network, . "Cancer-Related Fatigue, Version 2.2015." Journal of the National Comprehensive Cancer Network : Jnccn 13.8 (August 2015): 1012-1039.
PMID
26285247
Source
epmc
Published In
Jnccn Journal of the National Comprehensive Cancer Network
Volume
13
Issue
8
Publish Date
2015
Start Page
1012
End Page
1039
DOI
10.6004/jnccn.2015.0122

Polypharmacy in patients with advanced cancer and the role of medication discontinuation.

Polypharmacy is a well known problem in elderly patients in general, but its prevalence and effects in patients with cancer are less clear, particularly in end-of-life settings. This Review examines the existing literature on polypharmacy in advanced cancer and end-of-life settings by reviewing evidence-based approaches to reduce polypharmacy, and outlining the potential benefits of decreasing the number of drugs that patients with cancer can take, with emphasis on the need for thoughtful discontinuation initiatives in the context of life-limiting malignant disease. In view of the apparent burden of polypharmacy in patients with advanced cancer, we expect that greater attention to polypharmacy could lead to improvements in adverse drug events, cost, and possibly quality of life. However, few data for specific interventions in the advanced cancer population are available, and thus more research is warranted.

Authors
LeBlanc, TW; McNeil, MJ; Kamal, AH; Currow, DC; Abernethy, AP
MLA Citation
LeBlanc, TW, McNeil, MJ, Kamal, AH, Currow, DC, and Abernethy, AP. "Polypharmacy in patients with advanced cancer and the role of medication discontinuation." The Lancet. Oncology 16.7 (July 2015): e333-e341. (Review)
PMID
26149885
Source
epmc
Published In
The Lancet. Oncology
Volume
16
Issue
7
Publish Date
2015
Start Page
e333
End Page
e341
DOI
10.1016/s1470-2045(15)00080-7

Acute Myeloid Leukemia (AML) Patients Understanding of Prognosis and Treatment Goals: A Mixed-Methods Study.

Authors
LeBlanc, TW; Bloom, CT; Davis, DM; Locke, SC; Steinhauser, KE; Ubel, PA; Tulsky, JA; Abernethy, AP
MLA Citation
LeBlanc, TW, Bloom, CT, Davis, DM, Locke, SC, Steinhauser, KE, Ubel, PA, Tulsky, JA, and Abernethy, AP. "Acute Myeloid Leukemia (AML) Patients Understanding of Prognosis and Treatment Goals: A Mixed-Methods Study." May 20, 2015.
Source
wos-lite
Published In
Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology
Volume
33
Issue
15
Publish Date
2015

Symptom burden, quality of life, and distress in acute myeloid leukemia patients receiving induction chemotherapy: A prospective electronic patient-reported outcomes study.

Authors
LeBlanc, TW; Wolf, S; Davis, DM; Samsa, G; Locke, SC; Steinhauser, KE; Ubel, PA; Tulsky, JA; Abernethy, AP
MLA Citation
LeBlanc, TW, Wolf, S, Davis, DM, Samsa, G, Locke, SC, Steinhauser, KE, Ubel, PA, Tulsky, JA, and Abernethy, AP. "Symptom burden, quality of life, and distress in acute myeloid leukemia patients receiving induction chemotherapy: A prospective electronic patient-reported outcomes study." May 20, 2015.
Source
wos-lite
Published In
Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology
Volume
33
Issue
15
Publish Date
2015

Fatigue in long-term non-Hodgkin lymphoma survivors

Authors
Hudson, KE; Benecha, HK; Houck, KL; LeBlanc, TW; Abernethy, AP; Zimmerman, S; Ganz, PA; Smith, SK
MLA Citation
Hudson, KE, Benecha, HK, Houck, KL, LeBlanc, TW, Abernethy, AP, Zimmerman, S, Ganz, PA, and Smith, SK. "Fatigue in long-term non-Hodgkin lymphoma survivors." Annual Meeting of the American-Society-of-Clinical-Oncology (ASCO) / Clinical Science Symposium on Predicting and Improving Adverse Outcomes in Older Adults with Cancer. May 29, 2015 - June 2, 2015. Chicago, IL.: AMER SOC CLINICAL ONCOLOGY, May 20, 2015.
Source
wos
Published In
Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology
Volume
33
Issue
15
Publish Date
2015

Quality of life, depression, and end-of-life outcomes in hospitalized patients with advanced cancer

Authors
Hudson, KE; Wolf, SP; Abernethy, AP; LeBlanc, TW
MLA Citation
Hudson, KE, Wolf, SP, Abernethy, AP, and LeBlanc, TW. "Quality of life, depression, and end-of-life outcomes in hospitalized patients with advanced cancer." Annual Meeting of the American-Society-of-Clinical-Oncology (ASCO) / Clinical Science Symposium on Predicting and Improving Adverse Outcomes in Older Adults with Cancer. May 29, 2015 - June 2, 2015. Chicago, IL.: AMER SOC CLINICAL ONCOLOGY, May 20, 2015.
Source
wos
Published In
Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology
Volume
33
Issue
15
Publish Date
2015

Safety and benefit of discontinuing statin therapy in the setting of advanced, life-limiting illness: a randomized clinical trial.

For patients with limited prognosis, some medication risks may outweigh the benefits, particularly when benefits take years to accrue; statins are one example. Data are lacking regarding the risks and benefits of discontinuing statin therapy for patients with limited life expectancy.To evaluate the safety, clinical, and cost impact of discontinuing statin medications for patients in the palliative care setting.This was a multicenter, parallel-group, unblinded, pragmatic clinical trial. Eligibility included adults with an estimated life expectancy of between 1 month and 1 year, statin therapy for 3 months or more for primary or secondary prevention of cardiovascular disease, recent deterioration in functional status, and no recent active cardiovascular disease. Participants were randomized to either discontinue or continue statin therapy and were monitored monthly for up to 1 year. The study was conducted from June 3, 2011, to May 2, 2013. All analyses were performed using an intent-to-treat approach.Statin therapy was withdrawn from eligible patients who were randomized to the discontinuation group. Patients in the continuation group continued to receive statins.Outcomes included death within 60 days (primary outcome), survival, cardiovascular events, performance status, quality of life (QOL), symptoms, number of nonstatin medications, and cost savings.A total of 381 patients were enrolled; 189 of these were randomized to discontinue statins, and 192 were randomized to continue therapy. Mean (SD) age was 74.1 (11.6) years, 22.0% of the participants were cognitively impaired, and 48.8% had cancer. The proportion of participants in the discontinuation vs continuation groups who died within 60 days was not significantly different (23.8% vs 20.3%; 90% CI, -3.5% to 10.5%; P=.36) and did not meet the noninferiority end point. Total QOL was better for the group discontinuing statin therapy (mean McGill QOL score, 7.11 vs 6.85; P=.04). Few participants experienced cardiovascular events (13 in the discontinuation group vs 11 in the continuation group). Mean cost savings were $3.37 per day and $716 per patient.This pragmatic trial suggests that stopping statin medication therapy is safe and may be associated with benefits including improved QOL, use of fewer nonstatin medications, and a corresponding reduction in medication costs. Thoughtful patient-provider discussions regarding the uncertain benefit and potential decrement in QOL associated with statin continuation in this setting are warranted.clinicaltrials.gov Identifier: NCT01415934.

Authors
Kutner, JS; Blatchford, PJ; Taylor, DH; Ritchie, CS; Bull, JH; Fairclough, DL; Hanson, LC; LeBlanc, TW; Samsa, GP; Wolf, S; Aziz, NM; Currow, DC; Ferrell, B; Wagner-Johnston, N; Zafar, SY; Cleary, JF; Dev, S; Goode, PS; Kamal, AH; Kassner, C; Kvale, EA; McCallum, JG; Ogunseitan, AB; Pantilat, SZ; Portenoy, RK; Prince-Paul, M; Sloan, JA; Swetz, KM; Von Gunten, CF; Abernethy, AP
MLA Citation
Kutner, JS, Blatchford, PJ, Taylor, DH, Ritchie, CS, Bull, JH, Fairclough, DL, Hanson, LC, LeBlanc, TW, Samsa, GP, Wolf, S, Aziz, NM, Currow, DC, Ferrell, B, Wagner-Johnston, N, Zafar, SY, Cleary, JF, Dev, S, Goode, PS, Kamal, AH, Kassner, C, Kvale, EA, McCallum, JG, Ogunseitan, AB, Pantilat, SZ, Portenoy, RK, Prince-Paul, M, Sloan, JA, Swetz, KM, Von Gunten, CF, and Abernethy, AP. "Safety and benefit of discontinuing statin therapy in the setting of advanced, life-limiting illness: a randomized clinical trial." Jama Internal Medicine 175.5 (May 2015): 691-700.
PMID
25798575
Source
epmc
Published In
Jama Internal Medicine
Volume
175
Issue
5
Publish Date
2015
Start Page
691
End Page
700
DOI
10.1001/jamainternmed.2015.0289

Correlation between the international consensus definition of the Cancer Anorexia-Cachexia Syndrome (CACS) and patient-centered outcomes in advanced non-small cell lung cancer.

The cancer anorexia-cachexia syndrome (CACS) is common in patients with advanced solid tumors and is associated with adverse outcomes including poor quality of life (QOL), impaired functioning, and shortened survival.To apply the recently posed weight-based international consensus CACS definition to a population of patients with advanced non-small cell lung cancer (NSCLC) and explore its impact on patient-reported outcomes.Ninety-nine patients participated in up to four study visits over a six-month period. Longitudinal assessments included measures of physical function, QOL, and other clinical variables such as weight and survival.Patients meeting the consensus CACS criteria at Visit 1 had a significantly shorter median survival (239.5 vs. 446 days; hazard ratio, 2.06, P < 0.05). Physical function was worse in the CACS group (mean Karnofsky Performance Status score 68 vs. 77, Eastern Cooperative Oncology Group Performance Status score 1.8 vs. 1.3, P < 0.05 for both), as was QOL (Functional Assessment of Cancer Therapy-General [FACT-G] Lung Cancer subscale of 17.2 vs. 19.9, Anorexia/Cachexia subscale of 31.4 vs. 37.9, P < 0.05 for both). Differences in the FACT-G and the Functional Assessment of Chronic Illness Therapy-Fatigue subscale approached but did not reach statistical significance. Longitudinally, all measures of physical function and QOL worsened regardless of CACS status, but the rate of decline was more rapid in the CACS group.The weight-based component of the recently proposed international consensus CACS definition is useful in identifying patients with advanced NSCLC who are likely to have significantly inferior survival and who will develop more precipitous declines in physical function and QOL. This definition may be useful for clinical screening purposes and identify patients with high palliative care needs.

Authors
LeBlanc, TW; Nipp, RD; Rushing, CN; Samsa, GP; Locke, SC; Kamal, AH; Cella, DF; Abernethy, AP
MLA Citation
LeBlanc, TW, Nipp, RD, Rushing, CN, Samsa, GP, Locke, SC, Kamal, AH, Cella, DF, and Abernethy, AP. "Correlation between the international consensus definition of the Cancer Anorexia-Cachexia Syndrome (CACS) and patient-centered outcomes in advanced non-small cell lung cancer." Journal of Pain and Symptom Management 49.4 (April 2015): 680-689.
PMID
25461669
Source
epmc
Published In
Journal of Pain and Symptom Management
Volume
49
Issue
4
Publish Date
2015
Start Page
680
End Page
689
DOI
10.1016/j.jpainsymman.2014.09.008

What is different about patients with hematologic malignancies? A retrospective cohort study of cancer patients referred to a hospice research network.

CONTEXT: Although much is known about solid tumor patients who use hospice, the hematologic malignancies hospice population is inadequately described. OBJECTIVES: To compare the characteristics and outcomes of hospice patients with hematologic malignancies to those with solid tumors. METHODS: We extracted electronic patient data (2008-2012) from a large hospice network (Coalition of Hospices Organized to Investigate Comparative Effectiveness) and used bivariate analyses to describe between-group differences. RESULTS: In total, 48,147 patients with cancer were admitted during the study period; 3518 (7.3%) had a hematologic malignancy. These patients had significantly worse Palliative Performance Scale scores (32% vs. 24% were below 40; P < 0.001) and shorter lengths of stay (median 11 vs. 19 days; P < 0.001). They were more likely to die within 24 hours of hospice enrollment (10.9% vs. 6.8%; odds ratio [OR] 1.66; 95% CI 1.49, 1.86; P < 0.001) or within seven days (36% vs. 25.1%; OR 1.68; 95% CI 1.56, 1.81; P < 0.001) and were more likely to receive hospice services in an inpatient or nursing home setting (OR 1.34; 95% CI 1.16, 1.56 and OR 1.54; 95% CI 1.39, 1.72; both P < 0.001). Among hematologic malignancy patients, those with leukemia had the shortest survival (hazard ratio 1.23; 95% CI 1.13, 1.34; P < 0.001), and 40.3% used hospice for less than seven days (OR 1.31; 95% CI 1.11, 1.56; P = 0.002). CONCLUSION: Hospice patients with hematologic malignancies are more seriously ill at the time of admission, with worse functional status and shorter lengths of stay than other cancer patients. Differences in outcomes suggest the need for targeted interventions to optimize hospice services for the hematologic malignancies population, especially those with leukemia.

Authors
LeBlanc, TW; Abernethy, AP; Casarett, DJ
MLA Citation
LeBlanc, TW, Abernethy, AP, and Casarett, DJ. "What is different about patients with hematologic malignancies? A retrospective cohort study of cancer patients referred to a hospice research network." Journal of Pain and Symptom Management 49.3 (March 2015): 505-512.
PMID
25116911
Source
epmc
Published In
Journal of Pain and Symptom Management
Volume
49
Issue
3
Publish Date
2015
Start Page
505
End Page
512
DOI
10.1016/j.jpainsymman.2014.07.003

Perceptions of palliative care among hematologic malignancy specialists: a mixed-methods study.

Patients with hematologic malignancies are less likely to receive specialist palliative care services than patients with solid tumors. Reasons for this difference are poorly understood.This was a multisite, mixed-methods study to understand and contrast perceptions of palliative care among hematologic and solid tumor oncologists using surveys assessing referral practices and in-depth semistructured interviews exploring views of palliative care. We compared referral patterns using standard statistical methods. We analyzed qualitative interview data using constant comparative methods to explore reasons for observed differences.Among 66 interviewees, 23 oncologists cared exclusively for patients with hematologic malignancies; 43 treated only patients with solid tumors. Seven (30%) of 23 hematologic oncologists reported never referring to palliative care; all solid tumor oncologists had previously referred. In qualitative analyses, most hematologic oncologists viewed palliative care as end-of-life care, whereas most solid tumor oncologists viewed palliative care as a subspecialty that could assist with complex patient cases. Solid tumor oncologists emphasized practical barriers to palliative care referral, such as appointment availability and reimbursement issues. Hematologic oncologists emphasized philosophic concerns about palliative care referrals, including different treatment goals, responsiveness to chemotherapy, and preference for controlling even palliative aspects of patient care.Most hematologic oncologists view palliative care as end-of-life care, whereas solid tumor oncologists more often view palliative care as a subspecialty for comanaging patients with complex cases. Efforts to integrate palliative care into hematologic malignancy practices will require solutions that address unique barriers to palliative care referral experienced by hematologic malignancy specialists.

Authors
LeBlanc, TW; O'Donnell, JD; Crowley-Matoka, M; Rabow, MW; Smith, CB; White, DB; Tiver, GA; Arnold, RM; Schenker, Y
MLA Citation
LeBlanc, TW, O'Donnell, JD, Crowley-Matoka, M, Rabow, MW, Smith, CB, White, DB, Tiver, GA, Arnold, RM, and Schenker, Y. "Perceptions of palliative care among hematologic malignancy specialists: a mixed-methods study." Journal of Oncology Practice 11.2 (March 2015): e230-e238.
PMID
25784580
Source
epmc
Published In
J Oncol Pract
Volume
11
Issue
2
Publish Date
2015
Start Page
e230
End Page
e238
DOI
10.1200/JOP.2014.001859

Communication skills training in the twenty-first century.

Authors
LeBlanc, TW
MLA Citation
LeBlanc, TW. "Communication skills training in the twenty-first century." AMA journal of ethics 17.2 (February 2015): 140-143.
PMID
25676227
Source
epmc
Published In
Ama Journal of Ethics
Volume
17
Issue
2
Publish Date
2015
Start Page
140
End Page
143
DOI
10.1001/virtualmentor.2015.17.02.medu2-1502

Demystifying Nutritional Support in Cancer (FR451)

Authors
Prommer, E; LeBlanc, T; Kamal, A; Koesel, N; Szafranski, M
MLA Citation
Prommer, E, LeBlanc, T, Kamal, A, Koesel, N, and Szafranski, M. "Demystifying Nutritional Support in Cancer (FR451)." February 2015.
Source
crossref
Published In
Journal of Pain and Symptom Management
Volume
49
Issue
2
Publish Date
2015
Start Page
372
End Page
372
DOI
10.1016/j.jpainsymman.2014.11.113

Perceptions of Palliative Care Among Hematologic Malignancy Specialists: A Mixed-Methods Study (SA516-B)

Authors
LeBlanc, T; O'Donnell, J; Schenker, Y; White, D; Arnold, R
MLA Citation
LeBlanc, T, O'Donnell, J, Schenker, Y, White, D, and Arnold, R. "Perceptions of Palliative Care Among Hematologic Malignancy Specialists: A Mixed-Methods Study (SA516-B)." February 2015.
Source
crossref
Published In
Journal of Pain and Symptom Management
Volume
49
Issue
2
Publish Date
2015
Start Page
393
End Page
394
DOI
10.1016/j.jpainsymman.2014.11.157

Management of cancer pain

Authors
LeBlanc, TW; Abernethy, AP
MLA Citation
LeBlanc, TW, and Abernethy, AP. "Management of cancer pain." DeVita, Hellman, and Rosenberg's Cancer: Principles & Practice of Oncology: Tenth Edition. January 7, 2015.
Source
scopus
Publish Date
2015

When and why should patients with hematologic malignancies see a palliative care specialist?

Palliative care is a multidisciplinary approach to symptom management, psychosocial support, and assistance in treatment decision-making for patients with serious illness and their families. It emphasizes well-being at any point along the disease trajectory, regardless of prognosis. The term "palliative care" is often incorrectly used as a synonym for end-of-life care, or "hospice care". However, palliative care does not require a terminal diagnosis or proximity to death, a misconception that we will address in this article. Multiple randomized clinical trials demonstrate the many benefits of early integration of palliative care for patients with cancer, including reductions in symptom burden, improvements in quality-of-life, mood, and overall survival, as well as improved caregiver outcomes. Thus, early concurrent palliative care integrated with cancer-directed care has emerged as a standard-of-care practice for patients with cancer. However, patients with hematologic malignancies rarely utilize palliative care services, despite their many unmet palliative care needs, and are much less likely to use palliative care compared to patients with solid tumors. In this article, we will define "palliative care" and address some common misconceptions regarding its role as part of high-quality care for patients with cancer. We will then review the evidence supporting the integration of palliative care into comprehensive cancer care, discuss perceived barriers to palliative care in hematologic malignancies, and suggest opportunities and triggers for earlier and more frequent palliative care referral in this population.

Authors
LeBlanc, TW; El-Jawahri, A
MLA Citation
LeBlanc, TW, and El-Jawahri, A. "When and why should patients with hematologic malignancies see a palliative care specialist?." Hematology. American Society of Hematology. Education Program 2015 (January 2015): 471-478. (Review)
PMID
26637760
Source
epmc
Published In
Hematology. American Society of Hematology. Education Program
Volume
2015
Publish Date
2015
Start Page
471
End Page
478
DOI
10.1182/asheducation-2015.1.471

Early integration of palliative care into the care of patients with cancer.

Authors
Thienprayoon, R; LeBlanc, T
MLA Citation
Thienprayoon, R, and LeBlanc, T. "Early integration of palliative care into the care of patients with cancer." Hematology. American Society of Hematology. Education Program 2015 (January 2015): 479-483. (Review)
PMID
26637761
Source
epmc
Published In
Hematology. American Society of Hematology. Education Program
Volume
2015
Publish Date
2015
Start Page
479
End Page
483
DOI
10.1182/asheducation-2015.1.479

Clinician Approaches to Myeloma in Academia and the Community : An in-Practice Qualitative Study

Authors
LeBlanc, TW; Gasparetto, CJ; Tuchman, SA; Sheldon, P; Howson, A; Khan, ZM; Kaura, S; Abernethy, AP
MLA Citation
LeBlanc, TW, Gasparetto, CJ, Tuchman, SA, Sheldon, P, Howson, A, Khan, ZM, Kaura, S, and Abernethy, AP. "Clinician Approaches to Myeloma in Academia and the Community : An in-Practice Qualitative Study." 56th Annual Meeting of the American-Society-of-Hematology. December 6, 2014 - December 9, 2014. San Francisco, CA.: AMER SOC HEMATOLOGY, December 6, 2014.
Source
wos
Published In
Blood
Volume
124
Issue
21
Publish Date
2014

Prognostic Disclosure in Acute Myeloid Leukemia (AML): A Qualitative Study of Patient Preferences and Physician Practices

Authors
LeBlanc, TW; Bloom, CT; Davis, DM; Locke, SC; Steinhauser, KE; Ubel, PA; Tulsky, JA; Abernethy, AP
MLA Citation
LeBlanc, TW, Bloom, CT, Davis, DM, Locke, SC, Steinhauser, KE, Ubel, PA, Tulsky, JA, and Abernethy, AP. "Prognostic Disclosure in Acute Myeloid Leukemia (AML): A Qualitative Study of Patient Preferences and Physician Practices." BLOOD 124.21 (December 6, 2014).
Source
wos-lite
Published In
Blood
Volume
124
Issue
21
Publish Date
2014

Palliative care and hematologic malignancies: old dog, new tricks?

Authors
LeBlanc, TW
MLA Citation
LeBlanc, TW. "Palliative care and hematologic malignancies: old dog, new tricks?." Journal of oncology practice 10.6 (November 2014): e404-e407.
PMID
25398962
Source
epmc
Published In
Journal of Oncology Practice
Volume
10
Issue
6
Publish Date
2014
Start Page
e404
End Page
e407
DOI
10.1200/jop.2014.000968

Early palliative care on an inpatient oncology unit: Impact of a novel co-rounding partnership on patient and health system outcomes.

3 Background: Early palliative care (PC) improves outcomes for outpatients with advanced cancer, but its impact on an inpatient oncology unit is unknown. We implemented a novel inpatient medical oncology (ONC) and PC co-rounding partnership on September 1, 2011 at Duke University Hospital. Here we report its impact on patient and health system outcomes during its first year of implementation.We extracted patient data including demographics, cancer diagnosis, disease status, length of stay (LOS), ICU transfer rate, discharge disposition, time to ER return, time to readmission, and 7- and 30-day ER return and readmission rates (RR). Pre- and post-intervention cohorts were defined as all patients admitted or transferred to the solid tumor inpatient service from September 1, 2009-June 30, 2010 and September 1, 2011-June 30, 2012, respectively. Nursing and physician surveys assessed satisfaction. We used descriptive statistics, Student's t-test, and Fisher's exact test for analyses.The pre- and post-intervention analysis cohorts included 731 and 783 patients respectively, representing 2,353 encounters. Cohorts were similar in baseline characteristics, including mean age (61 vs. 62; p=0.07), gender (male: 51% vs. 48%; p=0.22), race (white: 68% vs. 71%; p=0.39), insurance coverage (Medicare: 49% vs. 51%; p=0.96), and disease status (recurrent/metastatic: 73% vs. 74%; p=0.6). Post-intervention patients had a statistically significant decrease in mean LOS (p=0.02) from 4.51 days (95% CI 4.3-4.73) to 4.17 days (95% CI 3.97-4.37), and statistically significant improvements in 7- and 30-day readmission rates, representing a 15% (p=0.03) and 23% (p=0.05) improvement, respectively. We observed a trend for increasing hospice referral (p=0.09) and a 15% decrease in ICU transfers. Physicians and nurses universally favored the model.A fully-integrated, inpatient co-rounding partnership between PC and ONC resulted in statistically significant improvements in key health system-related outcomes and indicators of quality cancer care.

Authors
Slusser, K; Power, S; Jones, CA; LeBlanc, TW; Kamal, A; Desai, D; Allen, D; Galanos, AN
MLA Citation
Slusser, K, Power, S, Jones, CA, LeBlanc, TW, Kamal, A, Desai, D, Allen, D, and Galanos, AN. "Early palliative care on an inpatient oncology unit: Impact of a novel co-rounding partnership on patient and health system outcomes." Journal of clinical oncology : official journal of the American Society of Clinical Oncology 32.31_suppl (November 2014): 3-.
PMID
28142849
Source
epmc
Published In
Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology
Volume
32
Issue
31_suppl
Publish Date
2014
Start Page
3

Electronic Health Records (EHRs) in the oncology clinic: how clinician interaction with EHRs can improve communication with the patient.

Authors
LeBlanc, TW; Back, AL; Danis, M; Abernethy, AP
MLA Citation
LeBlanc, TW, Back, AL, Danis, M, and Abernethy, AP. "Electronic Health Records (EHRs) in the oncology clinic: how clinician interaction with EHRs can improve communication with the patient." Journal of Oncology Practice 10.5 (September 2014): 317-321.
PMID
25027025
Source
epmc
Published In
J Oncol Pract
Volume
10
Issue
5
Publish Date
2014
Start Page
317
End Page
321
DOI
10.1200/JOP.2014.001385

Building the palliative care evidence base: Lessons from a randomized controlled trial of oxygen vs room air for refractory dyspnea.

Palliative care is increasingly seen as a standard component of high-quality comprehensive cancer care. However, several challenges remain to its widespread integration into clinical oncology practice, including workforce problems, reimbursement concerns, and a fledgling evidence base. This article discusses issues surrounding evidence base development in palliative cancer care, using the example of a recently published randomized controlled trial of oxygen versus room air. The Oxygen Trial randomized patients with refractory dyspnea and adequate Pao2 to oxygen or room air, administered via nasal cannula. Both groups experienced improvements in self-rated dyspnea scores, but no statistical differences were seen between intervention arms. These results suggest that supplementary oxygen is often unnecessary in the palliative setting, and that room air is similarly efficacious. This example highlights the importance and need for ongoing development of the evidence base in palliative medicine. The Palliative Care Research Cooperative (PCRC) is a novel National Institute of Nursing Research-funded research infrastructure that seeks to expand the palliative care evidence base. Its first multisite trial was recently completed, assessing the pragmatic question of whether statin medications can be safely discontinued in end-of-life settings. The PCRC will be a vehicle through which a high-quality evidence base will continue to expand and develop. Such ongoing research efforts are needed to inform and improve palliative care practice.

Authors
LeBlanc, TW; Abernethy, AP
MLA Citation
LeBlanc, TW, and Abernethy, AP. "Building the palliative care evidence base: Lessons from a randomized controlled trial of oxygen vs room air for refractory dyspnea." Journal of the National Comprehensive Cancer Network : JNCCN 12.7 (July 2014): 989-992.
PMID
24994919
Source
epmc
Published In
Jnccn Journal of the National Comprehensive Cancer Network
Volume
12
Issue
7
Publish Date
2014
Start Page
989
End Page
992
DOI
10.6004/jnccn.2014.0095

Rituximab for follicular lymphoma: watch and wait, watch and worry, or watch and live?

Authors
LeBlanc, T; Kamal, A; Abernethy, A
MLA Citation
LeBlanc, T, Kamal, A, and Abernethy, A. "Rituximab for follicular lymphoma: watch and wait, watch and worry, or watch and live?." The Lancet. Oncology 15.7 (June 2014): e251-e252. (Letter)
PMID
24872108
Source
epmc
Published In
The Lancet. Oncology
Volume
15
Issue
7
Publish Date
2014
Start Page
e251
End Page
e252
DOI
10.1016/s1470-2045(14)70215-3

Exploring variations in multiple myeloma management through in-practice research.

Authors
LeBlanc, TW; Gasparetto, C; Tuchman, SA; Sheldon, P; Howson, A; Turell, W; Khan, ZM; Kaura, S; Abernethy, AP
MLA Citation
LeBlanc, TW, Gasparetto, C, Tuchman, SA, Sheldon, P, Howson, A, Turell, W, Khan, ZM, Kaura, S, and Abernethy, AP. "Exploring variations in multiple myeloma management through in-practice research.": American Society of Clinical Oncology (ASCO), May 20, 2014.
Source
crossref
Published In
Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology
Volume
32
Issue
15_suppl
Publish Date
2014
Start Page
e19534
End Page
e19534
DOI
10.1200/jco.2014.32.15_suppl.e19534

Change in palliative performance scale score as prediction of survival in patients with advanced cancer.

Authors
Lee, YJ; Suh, S-Y; Kim, C; Yoon, JH; LeBlanc, TW; Choi, S-E; Seo, A-R; Ahn, H-Y
MLA Citation
Lee, YJ, Suh, S-Y, Kim, C, Yoon, JH, LeBlanc, TW, Choi, S-E, Seo, A-R, and Ahn, H-Y. "Change in palliative performance scale score as prediction of survival in patients with advanced cancer.": American Society of Clinical Oncology (ASCO), May 20, 2014.
Source
crossref
Published In
Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology
Volume
32
Issue
15_suppl
Publish Date
2014
Start Page
9561
End Page
9561
DOI
10.1200/jco.2014.32.15_suppl.9561

Correlation between the international consensus definition of the cancer anorexia cachexia syndrome (CACS) and patient outcomes in advanced non-small cell lung cancer (NSCLC).

Authors
Nipp, RD; Rushing, C; Samsa, G; Locke, SC; Kamal, A; Abernethy, AP; LeBlanc, TW
MLA Citation
Nipp, RD, Rushing, C, Samsa, G, Locke, SC, Kamal, A, Abernethy, AP, and LeBlanc, TW. "Correlation between the international consensus definition of the cancer anorexia cachexia syndrome (CACS) and patient outcomes in advanced non-small cell lung cancer (NSCLC).": American Society of Clinical Oncology (ASCO), May 20, 2014.
Source
crossref
Published In
Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology
Volume
32
Issue
15_suppl
Publish Date
2014
Start Page
e19042
End Page
e19042
DOI
10.1200/jco.2014.32.15_suppl.e19042

Patient understanding of medical jargon: a survey study of U.S. medical students.

OBJECTIVE: With increasing exposure, medical students may forget that technical jargon is unfamiliar to laypeople. To investigate this possibility, authors assessed student perceptions of patient understanding across different years in medical school. METHODS: 533 students at 4 U.S. medical schools rated the proportion of patients likely to understand each of twenty-one different jargon terms. Students were either in the first month of their first year, the middle of their first year, or the middle of their fourth year of medical school. RESULTS: Fourth-year students were slightly more pessimistic about patients' understanding compared to new first-year students (mean percent understanding of 55.1% vs. 58.6%, p=0.004). Students both over- and under-estimated patient understanding of specific words compared to published estimates. In a multivariate model, other factors did not explain these differences. CONCLUSION: Students do not generally presume that patients understand medical jargon. In many cases they actually underestimate patients' understanding, and these estimates may become more pessimistic longitudinally. Jargon use in communication with patients does not appear to stem from unrealistic presumptions about patients' understanding or from desensitization to jargon during medical school. PRACTICE IMPLICATIONS: Training about patient knowledge of medical jargon may be a useful addition to communication skills curricula.

Authors
LeBlanc, TW; Hesson, A; Williams, A; Feudtner, C; Holmes-Rovner, M; Williamson, LD; Ubel, PA
MLA Citation
LeBlanc, TW, Hesson, A, Williams, A, Feudtner, C, Holmes-Rovner, M, Williamson, LD, and Ubel, PA. "Patient understanding of medical jargon: a survey study of U.S. medical students." Patient education and counseling 95.2 (May 2014): 238-242.
PMID
24525222
Source
epmc
Published In
Patient Education and Counseling
Volume
95
Issue
2
Publish Date
2014
Start Page
238
End Page
242
DOI
10.1016/j.pec.2014.01.014

RESIDENT USE OF A READMISSIONS PREDICTION MODEL DECREASES TIME TO FOLLOW-UP AND IMPACTS TRUE READMISSION RATES

Authors
Schulteis, RD; LeBlanc, TW; Oddone, EZ; Simel, D
MLA Citation
Schulteis, RD, LeBlanc, TW, Oddone, EZ, and Simel, D. "RESIDENT USE OF A READMISSIONS PREDICTION MODEL DECREASES TIME TO FOLLOW-UP AND IMPACTS TRUE READMISSION RATES." April 2014.
Source
wos-lite
Published In
Journal of General Internal Medicine
Volume
29
Publish Date
2014
Start Page
S201
End Page
S201

On Goldilocks, care coordination, and palliative care: making it 'just right'.

Authors
LeBlanc, TW; Currow, DC; Abernethy, AP
MLA Citation
LeBlanc, TW, Currow, DC, and Abernethy, AP. "On Goldilocks, care coordination, and palliative care: making it 'just right'." Primary care respiratory journal : journal of the General Practice Airways Group 23.1 (March 2014): 8-10.
PMID
24553823
Source
epmc
Published In
Primary Care Respiratory Journal : Journal of the General Practice Airways Group
Volume
23
Issue
1
Publish Date
2014
Start Page
8
End Page
10
DOI
10.4104/pcrj.2014.00017

In the sandbox: palliative care and hematologic malignancies.

Palliative care specialists have had little involvement in the care of patients with hematologic malignancies. The reasons for this are not clear, because these patients certainly face a significant symptom burden, and many hematologic malignancies are either incurable or carry poor prognoses. For example, acute myeloid leukemia (AML) in patients over age 60 has a 5-year survival of less than 10%, akin to pancreatic cancer. Although most oncologists would agree with involving palliative care specialists in the case of advanced pancreatic cancer, few seem to consider this in the context of AML. Why should AML be any different?

Authors
LeBlanc, TW
MLA Citation
LeBlanc, TW. "In the sandbox: palliative care and hematologic malignancies." J Community Support Oncol 12.2 (February 2014): 44-45.
PMID
24971402
Source
pubmed
Published In
J Community Support Oncol
Volume
12
Issue
2
Publish Date
2014
Start Page
44
End Page
45

Palliative Care for Patients with Hematologic Malignancies: A Profile of Patients with Blood Cancers Referred to the CHOICE Hospice Network (S741)

Authors
LeBlanc, T; Abernathy, A; Casarett, D
MLA Citation
LeBlanc, T, Abernathy, A, and Casarett, D. "Palliative Care for Patients with Hematologic Malignancies: A Profile of Patients with Blood Cancers Referred to the CHOICE Hospice Network (S741)." February 2014.
Source
crossref
Published In
Journal of Pain and Symptom Management
Volume
47
Issue
2
Publish Date
2014
Start Page
490
End Page
490
DOI
10.1016/j.jpainsymman.2013.12.159

On Goldilocks, care coordination, and palliative care: Making it 'just right'

Authors
LeBlanc, TW; Currow, DC; Abernethy, AP
MLA Citation
LeBlanc, TW, Currow, DC, and Abernethy, AP. "On Goldilocks, care coordination, and palliative care: Making it 'just right'." Primary Care Respiratory Journal 23.1 (January 1, 2014): 8-10.
Source
scopus
Published In
Primary Care Respiratory Journal : Journal of the General Practice Airways Group
Volume
23
Issue
1
Publish Date
2014
Start Page
8
End Page
10
DOI
10.4104/pcrj.2014.00017

Patient understanding of medical jargon: A survey study of U.S. medical students

Objective: With increasing exposure, medical students may forget that technical jargon is unfamiliar to laypeople. To investigate this possibility, authors assessed student perceptions of patient understanding across different years in medical school. Methods: 533 students at 4 U.S. medical schools rated the proportion of patients likely to understand each of twenty-one different jargon terms. Students were either in the first month of their first year, the middle of their first year, or the middle of their fourth year of medical school. Results: Fourth-year students were slightly more pessimistic about patients' understanding compared to new first-year students (mean percent understanding of 55.1% vs. 58.6%, p= 0.004). Students both over- and under-estimated patient understanding of specific words compared to published estimates. In a multivariate model, other factors did not explain these differences. Conclusion: Students do not generally presume that patients understand medical jargon. In many cases they actually underestimate patients' understanding, and these estimates may become more pessimistic longitudinally. Jargon use in communication with patients does not appear to stem from unrealistic presumptions about patients' understanding or from desensitization to jargon during medical school. Practice implications: Training about patient knowledge of medical jargon may be a useful addition to communication skills curricula. © 2014 Elsevier Ireland Ltd.

Authors
LeBlanc, TW; Hesson, A; Williams, A; Feudtner, C; Holmes-Rovner, M; Williamson, LD; Ubel, PA
MLA Citation
LeBlanc, TW, Hesson, A, Williams, A, Feudtner, C, Holmes-Rovner, M, Williamson, LD, and Ubel, PA. "Patient understanding of medical jargon: A survey study of U.S. medical students." Patient Education and Counseling 95.2 (January 1, 2014): 238-242.
Source
scopus
Published In
Patient Education and Counseling
Volume
95
Issue
2
Publish Date
2014
Start Page
238
End Page
242
DOI
10.1016/j.pec.2014.01.014

Palliative Care For Patients With Hematologic Malignancies: A Profile Of Patients With Blood Cancers Referred To The Choice Hospice Network

Authors
LeBlanc, TW; Abernethy, AP; Casarett, DJ
MLA Citation
LeBlanc, TW, Abernethy, AP, and Casarett, DJ. "Palliative Care For Patients With Hematologic Malignancies: A Profile Of Patients With Blood Cancers Referred To The Choice Hospice Network." 55th Annual Meeting of the American-Society-of-Hematology. December 7, 2013 - December 10, 2013. New Orleans, LA.: AMER SOC HEMATOLOGY, November 15, 2013.
Source
wos
Published In
Blood
Volume
122
Issue
21
Publish Date
2013

Overcoming recruitment challenges in palliative care clinical trials.

Palliative care is increasingly viewed as a necessary component of cancer care, especially for patients with advanced disease. Rigorous clinical trials are thus needed to build the palliative care evidence base, but clinical research-especially participant recruitment-is difficult. Major barriers include (1) patient factors, (2) "gatekeeping," and (3) ethical concerns. Here we discuss an approach to overcoming these barriers, using the Palliative Care Trial (PCT) as a case study.The PCT was a 2 × 2 × 2 factorial randomized controlled trial (RCT) of different service delivery models to improve pain control in the palliative setting. It used a recruitment protocol that fused evidence-based strategies with principles of "social marketing," an approach involving the systematic application of marketing techniques. Main components included (1) an inclusive triage algorithm, (2) information booklets targeting particular stakeholders, (3) a specialized recruitment nurse, and (4) standardization of wording across all study communications.From an eligible pool of 607 patients, the PCT enrolled 461 patients over 26 months. Twenty percent of patients referred to the palliative care service were enrolled (76% of those eligible after screening). Several common barriers were minimized; among those who declined participation, family disinterest was uncommon (5%), as was the perception of burden imposed (4%).Challenges to clinical trial recruitment in palliative care are significant but not insurmountable. A carefully crafted recruitment and retention protocol can be effective. Our experience with designing and deploying a social-marketing-based protocol shows the benefits of such an approach.

Authors
LeBlanc, TW; Lodato, JE; Currow, DC; Abernethy, AP
MLA Citation
LeBlanc, TW, Lodato, JE, Currow, DC, and Abernethy, AP. "Overcoming recruitment challenges in palliative care clinical trials." Journal of Oncology Practice 9.6 (November 2013): 277-282.
PMID
24130254
Source
epmc
Published In
J Oncol Pract
Volume
9
Issue
6
Publish Date
2013
Start Page
277
End Page
282
DOI
10.1200/JOP.2013.000996

Defining quality, disseminating evidence, and enforcing guidelines for cancer treatment.

Authors
Leblanc, TW; Abernethy, AP
MLA Citation
Leblanc, TW, and Abernethy, AP. "Defining quality, disseminating evidence, and enforcing guidelines for cancer treatment. (Published online)" Virtual Mentor 15.8 (August 1, 2013): 713-717.
PMID
23937789
Source
pubmed
Published In
The Virtual Mentor : Vm
Volume
15
Issue
8
Publish Date
2013
Start Page
713
End Page
717
DOI
10.1001/virtualmentor.2013.15.8.oped1-1308

Oncologists' perceptions of rounding alongside palliative care physicians: Results of a post-intervention survey study.

Authors
LeBlanc, TW; Tulsky, JA; Abernethy, AP; Jones, CA; Galanos, AN; Riedel, RF
MLA Citation
LeBlanc, TW, Tulsky, JA, Abernethy, AP, Jones, CA, Galanos, AN, and Riedel, RF. "Oncologists' perceptions of rounding alongside palliative care physicians: Results of a post-intervention survey study." May 20, 2013.
Source
wos-lite
Published In
Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology
Volume
31
Issue
15
Publish Date
2013

Cancer anorexia-cachexia syndrome in advanced lung cancer: An exploratory analysis of patient-reported outcomes data.

Authors
Nipp, RD; Locke, SC; Samsa, G; Kamal, A; Abernethy, AP; LeBlanc, TW
MLA Citation
Nipp, RD, Locke, SC, Samsa, G, Kamal, A, Abernethy, AP, and LeBlanc, TW. "Cancer anorexia-cachexia syndrome in advanced lung cancer: An exploratory analysis of patient-reported outcomes data." 49th Annual Meeting of the American-Society-of-Clinical-Oncology (ASCO). May 31, 2013 - June 4, 2013. Chicago, IL.: AMER SOC CLINICAL ONCOLOGY, May 20, 2013.
Source
wos
Published In
Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology
Volume
31
Issue
15
Publish Date
2013

Considerations in reporting palliative care clinical trials: standardizing information reported and authorship practices (vol 6, pg 494, 2012)

Authors
LeBlanc, TW; Abernethy, AP; Currow, DC; Kutner, JS
MLA Citation
LeBlanc, TW, Abernethy, AP, Currow, DC, and Kutner, JS. "Considerations in reporting palliative care clinical trials: standardizing information reported and authorship practices (vol 6, pg 494, 2012)." Current Opinion in Supportive and Palliative Care 7.1 (March 1, 2013): 129-129.
Source
wos
Published In
Current Opinion in Supportive and Palliative Care
Volume
7
Issue
1
Publish Date
2013
Start Page
129
End Page
129

The message isn't as mean as we may think.

Authors
LeBlanc, TW
MLA Citation
LeBlanc, TW. "The message isn't as mean as we may think. (Published online)" Virtual Mentor 15.1 (January 1, 2013): 82-85.
PMID
23356813
Source
pubmed
Published In
The Virtual Mentor : Vm
Volume
15
Issue
1
Publish Date
2013
Start Page
82
End Page
85
DOI
10.1001/virtualmentor.2013.15.1.mnar2-1301

The ethics of health information technology in oncology: emerging isssues from both local and global perspectives.

Health information technology (HIT) is ever-increasing in complexity and has incrementally become a fundamental part of our everyday clinical lives. As HIT becomes more complex and commonplace, so do the questions it raises about stewardship and usage of data, along with the ethics of these applications. With the development of rapid-learning systems, such as ASCO's CancerLinQ, careful thought about the ethics and applications of these technologies is necessary. This article uses the principles-based framework of modern bioethics to examine evolving ethical issues that arise in the context of HIT and also discusses HIT's application in reducing cancer care disparities in the developing world. We recognize that this topic is quite broad, so here we provide an overview of the issues, rather than any definitive conclusions about a particular "correct path." Our hope is to stimulate discussion about this important topic, which will increasingly need to be addressed in the oncology community.

Authors
LeBlanc, TW; Shulman, LN; Yu, PP; Hirsch, BR; Abernethy, AP
MLA Citation
LeBlanc, TW, Shulman, LN, Yu, PP, Hirsch, BR, and Abernethy, AP. "The ethics of health information technology in oncology: emerging isssues from both local and global perspectives." American Society of Clinical Oncology Educational Book. American Society of Clinical Oncology. Annual Meeting (January 2013): 136-142. (Review)
PMID
23714480
Source
epmc
Published In
American Society of Clinical Oncology Educational Book. American Society of Clinical Oncology. Meeting
Publish Date
2013
Start Page
136
End Page
142
DOI
10.1200/edbook_am.2013.33.136

Quality of life in higher resolution: The next generation of comparative effectiveness research in malignant hematology

Authors
LeBlanc, TW; Abernethy, AP
MLA Citation
LeBlanc, TW, and Abernethy, AP. "Quality of life in higher resolution: The next generation of comparative effectiveness research in malignant hematology." Haematologica 98.6 (2013): 823-824.
PMID
23729721
Source
scival
Published In
Haematologica the Hematology Journal
Volume
98
Issue
6
Publish Date
2013
Start Page
823
End Page
824
DOI
10.3324/haematol.2013.085787

Discontinuation of statins in routine care settings

Authors
LeBlanc, TW; Kutner, JS; Ritchie, CS; Abernethy, AP
MLA Citation
LeBlanc, TW, Kutner, JS, Ritchie, CS, and Abernethy, AP. "Discontinuation of statins in routine care settings." Annals of Internal Medicine 159.1 (2013): 74-75.
PMID
23817715
Source
scival
Published In
Annals of Internal Medicine
Volume
159
Issue
1
Publish Date
2013
Start Page
74
End Page
75
DOI
10.7326/0003-4819-159-1-201307020-00021

Considerations in reporting palliative care clinical trials: standardizing information reported and authorship practices.

The nature of palliative care practice, especially the reliance on referrals and differing models of service delivery, poses unique challenges for the creation and interpretation of an evidence base, frequently limiting the applicability of data to patient care. Here we discuss two core aspects of clinical trials reporting in palliative medicine: proposed standards governing the collection and reporting of data, and rules governing authorship and publication.Existing literature often inadequately describes the characteristics of patients, caregivers, clinicians, systems, and interventions included in studies, thereby limiting the utility of results.A generalizability framework is needed to ensure a robust evidence base that advances practice. Lessons learned through the development of research cooperative groups in palliative care reinforce the importance of an authorship protocol for large trials and working groups.

Authors
LeBlanc, TW; Abernethy, AP; Currow, DC; Kutner, JS
MLA Citation
LeBlanc, TW, Abernethy, AP, Currow, DC, and Kutner, JS. "Considerations in reporting palliative care clinical trials: standardizing information reported and authorship practices." Current Opinion in Supportive and Palliative Care 6.4 (December 2012): 494-499. (Review)
PMID
23080306
Source
epmc
Published In
Current Opinion in Supportive and Palliative Care
Volume
6
Issue
4
Publish Date
2012
Start Page
494
End Page
499
DOI
10.1097/SPC.0b013e3283597259

The need for community-based palliative care for patients living with cancer

Authors
LeBlanc, TW; Abernethy, AP
MLA Citation
LeBlanc, TW, and Abernethy, AP. "The need for community-based palliative care for patients living with cancer." Oncology 25.13 (December 1, 2011).
Source
scopus
Published In
Oncology (Williston Park, N.Y.)
Volume
25
Issue
13
Publish Date
2011

Palliative care and oncology: integration leads to better care.

Authors
LeBlanc, TW; Abernethy, AP
MLA Citation
LeBlanc, TW, and Abernethy, AP. "Palliative care and oncology: integration leads to better care." Oncology (Williston Park, N.Y.) 25.13 (November 2011): 1275-. (Academic Article)
PMID
22272496
Source
manual
Published In
Oncology (Williston Park, N.Y.)
Volume
25
Issue
13
Publish Date
2011
Start Page
1275

Longitudinal patient-reported performance status assessment in the cancer clinic is feasible and prognostic.

Performance status is prognostic in oncology and palliative care settings. Traditionally clinician rated, it is often inconsistently collected, recorded, and measured, thereby limiting its utility. Patient-reported strategies are increasingly used for routine symptom and quality of life assessment in the clinic, and may be useful for tracking performance status.Tablet personal computers were used to collect patient-reported reviews of systems via the Patient Care Monitor (PCM) v2.0 for 86 patients with advanced lung cancer. Relevant subscales included the PCM Impaired Performance and Impaired Ambulation scales. Trained nurse clinicians measured performance status using traditional Karnofsky and Eastern Cooperative Oncology Group (ECOG) instruments. Correlation coefficients were used to compare performance status scales, and survival analysis was performed by Cox proportional hazards modeling.All four performance status scales demonstrated excellent internal consistency and convergent validity. Initial KPS and ECOG scores were statistically correlated with survival, whereas PCM scores showed a nonsignificant trend in this direction. Change in PCM Impaired Performance over time was statistically correlated with survival (hazard ratio = 1.62, P = .046), whereas the other three performance status measures were not statistically prognostic.Patient-reported performance status as measured by PCM v2.0 is at least as reliable as KPS or ECOG. The enhanced resolution provided by this patient-reported method allows for the detection of clinically meaningful changes in trajectory over time, potentially serving as an early-warning system to trigger clinical interventions. Further study is needed to test these findings on a larger scale.

Authors
Suh, S-Y; Leblanc, TW; Shelby, RA; Samsa, GP; Abernethy, AP
MLA Citation
Suh, S-Y, Leblanc, TW, Shelby, RA, Samsa, GP, and Abernethy, AP. "Longitudinal patient-reported performance status assessment in the cancer clinic is feasible and prognostic." Journal of Oncology Practice 7.6 (November 2011): 374-381.
PMID
22379420
Source
epmc
Published In
Journal of Oncology Practice
Volume
7
Issue
6
Publish Date
2011
Start Page
374
End Page
381
DOI
10.1200/JOP.2011.000434

Linking palliative care and oncology practice: performance status as a common thread.

Authors
Leblanc, TW; Back, AL
MLA Citation
Leblanc, TW, and Back, AL. "Linking palliative care and oncology practice: performance status as a common thread." Journal of Oncology Practice 7.6 (November 2011): 381-382.
PMID
22379421
Source
epmc
Published In
Journal of Oncology Practice
Volume
7
Issue
6
Publish Date
2011
Start Page
381
End Page
382
DOI
10.1200/JOP.2011.000462

Autopsy and Grief: A Case of Transformative Postmortem Examination.

Abstract Background: A physician's obligations to deliver compassionate care do not end with a patient's death. When a patient dies there remains a responsibility to assist grieving family members. Unfortunately, many physicians feel ill prepared to assist in the bereavement process, not knowing what to say or how to say it. Although underutilized, the medical autopsy can play an important role in families' grief processes, particularly in those cases wherein uncertainties exist regarding the ultimate cause of death. Discussion: Here we postulate a role for the medical autopsy in assisting families through the grief process, which we demonstrate via an illustrative case. Effective communication of these results to family members is the key to its therapeutic effect.

Authors
Leblanc, TW; Tulsky, JA; Simel, DL
MLA Citation
Leblanc, TW, Tulsky, JA, and Simel, DL. "Autopsy and Grief: A Case of Transformative Postmortem Examination." Journal of palliative medicine (August 2011). (Academic Article)
PMID
21815752
Source
manual
Published In
Journal of Palliative Medicine
Publish Date
2011
DOI
10.1089/jpm.2011.0044

What is the role of friends when contributing care at the end of life? Findings from an Australian population study.

OBJECTIVE: To examine the role of friends as caregivers of people with terminal illness. METHODS: Piloted questions were included in the 2001-2007 random face-to-face annual health surveys of 23588 South Australians on the death of a loved one, caregiving provided, and characteristics of the caregiver and deceased individual. The survey was representative of the population by age, gender, and region of residence. Analyses focused on friends of the deceased loved one, providing daily or intermittent 'hands on' care. Logistic regression assessed predictors of home death. RESULTS: Daily 'hands on' carers were much more likely to be female and aged between 55 and 64; there was also a younger (12 months. Home deaths were more frequent (32%, p=0.014) when friends were carers, and the rate of palliative care use was higher than when family/others provided care (70 vs 61%). Regression analyses confirmed friends as caregivers as a predictor of home death (OR 1.73: 95%, CI 1.15-2.87). CONCLUSIONS: Friends contribute their caregiving: A cohort of younger caregivers may reflect changing social mores as the extended family shrinks and people turn to friendship networks for care and support at the end of life.

Authors
Burns, CM; Abernethy, AP; Leblanc, TW; Currow, DC
MLA Citation
Burns, CM, Abernethy, AP, Leblanc, TW, and Currow, DC. "What is the role of friends when contributing care at the end of life? Findings from an Australian population study." Psycho-oncology 20.2 (February 2011): 203-212. (Academic Article)
PMID
20238373
Source
manual
Published In
Psychooncology
Volume
20
Issue
2
Publish Date
2011
Start Page
203
End Page
212
DOI
10.1002/pon.1725

Young caregivers in the end-of-life setting: a population-based profile of an emerging group.

OBJECTIVE: Little is known about young caregivers of people with advanced life-limiting illness. Better understanding of the needs and characteristics of these young caregivers can inform development of palliative care and other support services. METHODS: A population-based analysis of caregivers was performed from piloted questions included in the 2001-2007 face-to-face annual health surveys of 23,706 South Australians on the death of a loved one, caregiving provided, and characteristics of the deceased individual and caregiver. The survey was representative of the population by age, gender, and region of residence. RESULTS: Most active care was provided by older, close family members, but large numbers of young people (ages 15-29) also provided assistance to individuals with advanced life-limiting illness. They comprised 14.4% of those undertaking "hands-on" care on a daily or intermittent basis, whom we grouped together as active caregivers. Almost as many young males as females participate in active caregiving (men represent 46%); most provide care while being employed, including 38% who work full-time. Over half of those engaged in hands-on care indicated the experience to be worse or much worse than expected, with young people more frequently reporting dissatisfaction thereof. Young caregivers also exhibited an increased perception of the need for assistance with grief. CONCLUSIONS: Young people can be integral to end-of-life care, and represent a significant cohort of active caregivers with unique needs and experiences. They may have a more negative experience as caregivers, and increased needs for grief counseling services compared to other age cohorts of caregivers.

Authors
Burns, CM; LeBlanc, TW; Abernethy, A; Currow, D
MLA Citation
Burns, CM, LeBlanc, TW, Abernethy, A, and Currow, D. "Young caregivers in the end-of-life setting: a population-based profile of an emerging group." Journal of palliative medicine 13.10 (October 2010): 1225-1235. (Academic Article)
Website
http://hdl.handle.net/10161/3367
PMID
20858060
Source
manual
Published In
Journal of Palliative Medicine
Volume
13
Issue
10
Publish Date
2010
Start Page
1225
End Page
1235
DOI
10.1089/jpm.2010.0004

Research in end-of-life settings: an ethical inquiry.

A fundamental tension surrounds the ethics of conducting research in vulnerable populations, and specifically, research involving patients at or near the end-of-life. In Palliative Medicine, these patients' care has historically been based on compassion, clinical judgment and experience, and anecdote rather than on data generated through high-quality clinical trials. A robust evidence base to support clinical practice in the end-of-life setting is lacking. Multiple ethical objections to the conduct of research at the end of life have impeded efforts to build such an evidence base. Arguments can be categorized into claims that the goals of research conflict with the goals of care; research unduly burdens vulnerable patients and families/caregivers; genuine equipoise does not exist; and research in the palliative care setting is too difficult. The authors explore and respond to these objections, noting the vital importance of research at this stage of the illness trajectory. The authors conclude that barriers to palliative care research are surmountable, and, indeed, that the "research imperative" and principles laid out in the Belmont Report of 1979 require us to rigorously study clinical interventions used for palliative care patients-so as to provide optimal safety and outcomes for present and future patients.

Authors
LeBlanc, TW; Wheeler, JL; Abernethy, AP
MLA Citation
LeBlanc, TW, Wheeler, JL, and Abernethy, AP. "Research in end-of-life settings: an ethical inquiry." Journal of pain & palliative care pharmacotherapy 24.3 (September 2010): 244-250. (Academic Article)
PMID
20718645
Source
manual
Published In
Journal of Pain & Palliative Care Pharmacotherapy (Haworth)
Volume
24
Issue
3
Publish Date
2010
Start Page
244
End Page
250
DOI
10.3109/15360288.2010.493579

Developing the evidence base for palliative care: formation of the palliative care research cooperative and its first trial.

The field of palliative care and hospice has gained accreditation, with a growing cadre of specialists being trained, but there is a dearth of robust research evidence to guide clinical practice. After 2 years of planning, a group of senior investigators convened in January 2010 to explore the possibility of forming a research cooperative group dedicated to advancing the evidence base in palliative care and hospice. The meeting launched the Palliative Care Research Cooperative (PCRC) with an initial national/international membership, and a plan for developing policies and procedures. Proof of the concept for the PCRC is being established through the design, conduct, and dissemination of a multi-site clinical trial targeting a consensually selected, clinically relevant research question: Should patients who are taking statins for primary or secondary prevention, and who have a prognosis of

Authors
Leblanc, TW; Kutner, JS; Ko, D; Wheeler, JL; Bull, J; Abernethy, AP
MLA Citation
Leblanc, TW, Kutner, JS, Ko, D, Wheeler, JL, Bull, J, and Abernethy, AP. "Developing the evidence base for palliative care: formation of the palliative care research cooperative and its first trial." Hospital practice 38.5 (August 2010): 137-143. (Academic Article)
PMID
20890063
Source
manual
Published In
Hospital Practice (1995)
Volume
38
Issue
5
Publish Date
2010
Start Page
137
End Page
143
DOI
10.3810/hp.2010.06.320

Acute eosinophilic pneumonia secondary to daptomycin: a report of three cases.

We describe 3 cases of daptomycin-induced pulmonary toxic effects that are consistent with drug-induced acute eosinophilic pneumonia. Patients presented similarly with dyspnea, cough, hypoxia, and diffuse ground-glass opacities at chest computed tomography. Clinical suspicion for this adverse drug event and cessation of daptomycin until definitive diagnosis can be made is crucial.

Authors
Miller, BA; Gray, A; Leblanc, TW; Sexton, DJ; Martin, AR; Slama, TG
MLA Citation
Miller, BA, Gray, A, Leblanc, TW, Sexton, DJ, Martin, AR, and Slama, TG. "Acute eosinophilic pneumonia secondary to daptomycin: a report of three cases." Clinical Infectious Diseases: an Official Publication of the Infectious Diseases Society of America 50.11 (June 2010): e63-e68.
Website
http://hdl.handle.net/10161/4150
PMID
20420515
Source
epmc
Published In
Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America
Volume
50
Issue
11
Publish Date
2010
Start Page
e63
End Page
e68
DOI
10.1086/652656

Grief, interrupted.

Authors
LeBlanc, TW
MLA Citation
LeBlanc, TW. "Grief, interrupted." Journal of Palliative Medicine 13.4 (April 2010): 469-470.
Website
http://hdl.handle.net/10161/3359
PMID
20384508
Source
epmc
Published In
Journal of Palliative Medicine
Volume
13
Issue
4
Publish Date
2010
Start Page
469
End Page
470
DOI
10.1089/jpm.2009.0348

A comparative resident site visit project: A novel approach for implementing programmatic change in the duty hours era

The Duke University Medical Center Internal Medicine Residency Program did not reach its anticipated quota of applicants during the 2008 National Residency Matching Program. Post-Match feedback regarding workload prompted an effort to redesign the general medicine service. As part of that effort, Duke program leaders sought to learn how peer programs accommodated Accreditation Council for Graduate Medical Education (ACGME) regulations. They launched the Resident Site Visit Project (RSVP).In 2008, Duke resident teams visited six other academic internal medicine residency programs based in university hospitals in the eastern United States. They conducted a systematic survey using a standardized questionnaire, interviewed program leaders and residents, and observed workflow directly. The RSVP identified strategies for accommodating ACGME rules in service design and also highlighted challenges shared by all of the programs.Discussion of the shared challenges yielded six core principles that directly guided Duke's general medicine service redesign: emphasize patient safety, reduce resident work compression, create educational opportunities, ensure automatic duty hours compliance, preserve essential program attributes, and involve stakeholders in the process of change.The Duke RSVP is an approach to programmatic change that applies information collected during site visits in defining core principles for program redesign. Collaboration between programs through resident site visits facilitates innovation, creates a foundation for change that increases stakeholder involvement, and generates opportunities for multicenter research. © by the Association of American Medical Colleges.

Authors
Crowley, MJ; Barkauskas, CE; Srygley, FD; Kransdorf, EP; Leblanc, TW; Simel, DL; McNeill, DB
MLA Citation
Crowley, MJ, Barkauskas, CE, Srygley, FD, Kransdorf, EP, Leblanc, TW, Simel, DL, and McNeill, DB. "A comparative resident site visit project: A novel approach for implementing programmatic change in the duty hours era." Academic Medicine 85.7 (2010): 1140-1146.
PMID
20592509
Source
scival
Published In
Academic Medicine : Journal of the Association of American Medical Colleges
Volume
85
Issue
7
Publish Date
2010
Start Page
1140
End Page
1146
DOI
10.1097/ACM.0b013e3181e18cee

Primary care--lifelines and shortages.

Authors
LeBlanc, TW
MLA Citation
LeBlanc, TW. "Primary care--lifelines and shortages." The New England Journal of Medicine 361.14 (October 2009): 1414-null. (Letter)
PMID
19802922
Source
epmc
Published In
The New England Journal of Medicine
Volume
361
Issue
14
Publish Date
2009
Start Page
1414

Is there a duty to inform patients of phase I trials?

Authors
Bruce, CR; Flamm, AL; Leblanc, TW; Rosoff, PM
MLA Citation
Bruce, CR, Flamm, AL, Leblanc, TW, and Rosoff, PM. "Is there a duty to inform patients of phase I trials? (Published online)." Virtual Mentor 11.3 (March 1, 2009): 207-214.
PMID
23194901
Source
pubmed
Published In
The Virtual Mentor : Vm
Volume
11
Issue
3
Publish Date
2009
Start Page
207
End Page
214
DOI
10.1001/virtualmentor.2009.11.3.ccas2-0903

Early evidence of unprofessional behavior found in medical student records.

Authors
Leblanc, T
MLA Citation
Leblanc, T. "Early evidence of unprofessional behavior found in medical student records. (Published online)" Virtual Mentor 9.4 (April 1, 2007): 290-294.
PMID
23217972
Source
pubmed
Published In
The Virtual Mentor : Vm
Volume
9
Issue
4
Publish Date
2007
Start Page
290
End Page
294
DOI
10.1001/virtualmentor.2007.9.4.jdsc1-0704

Compassionate care at the end of life.

Authors
Leblanc, T
MLA Citation
Leblanc, T. "Compassionate care at the end of life. (Published online)" Virtual Mentor 8.9 (September 1, 2006): 557-558.
PMID
23234703
Source
pubmed
Published In
The Virtual Mentor : Vm
Volume
8
Issue
9
Publish Date
2006
Start Page
557
End Page
558
DOI
10.1001/virtualmentor.2006.8.9.fred1-0609

CPR: Is It Always an Appropriate Option?

Authors
Leblanc, T
MLA Citation
Leblanc, T. "CPR: Is It Always an Appropriate Option? (Published online)." Virtual Mentor 8.9 (September 1, 2006): 586-589.
PMID
23234709
Source
pubmed
Published In
The Virtual Mentor : Vm
Volume
8
Issue
9
Publish Date
2006
Start Page
586
End Page
589
DOI
10.1001/virtualmentor.2006.8.9.jdsc1-0609
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Research Areas:

  • Aged
  • Attitude of Health Personnel
  • Attitude to Death
  • Attitude to Health
  • Cardiovascular Diseases
  • Clinical Competence
  • Clinical Trials as Topic
  • Cognition Disorders
  • Communication
  • Comparative Effectiveness Research
  • Decision Making
  • Diffusion of Innovation
  • Dyspnea
  • Ethics
  • Evidence-Based Medicine
  • Guideline Adherence
  • Health Services Research
  • Hematologic Neoplasms
  • Hospice Care
  • Information Dissemination
  • Inpatients
  • Jargon
  • Leukemia
  • Lung Neoplasms
  • Lymphoma
  • Medical education
  • Myelodysplastic Syndromes
  • Myeloproliferative Disorders
  • Neoplasms
  • Nonverbal Communication
  • Odds Ratio
  • Oncology Service, Hospital
  • Outcome Assessment (Health Care)
  • Oxygen
  • Pain
  • Pain Management
  • Palliative Care
  • Patient Selection
  • Patient-Centered Care
  • Perception
  • Prognosis
  • Quality of Health Care
  • Statistics as Topic
  • Terminal Care
  • Treatment Outcome
  • Withholding Treatment