1
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Chang J, Han KT, Medina M, Kim SJ. Palliative care and healthcare utilization among deceased metastatic lung cancer patients in U.S. hospitals. BMC Palliat Care 2022; 21:136. [PMID: 35897031 PMCID: PMC9327255 DOI: 10.1186/s12904-022-01026-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 07/19/2022] [Indexed: 11/24/2022] Open
Abstract
Objective The benefits of palliative care for cancer patients were well developed; however, the characteristics of receiving palliative care and the utilization patterns among lung cancer patients have not been explored using a large-scale representative population-based sample. Methods The National Inpatient Sample of the United States was used to identify deceased metastatic lung cancer patients (n = 5,068, weighted n = 25,121) from 2010 to 2014. We examined the characteristics of receiving palliative care use and the association between palliative care and healthcare utilization, measured by discounted hospital charges and LOS (length of stay). The multivariate survey logistic regression model (to identify predictors for receipts of palliative care) and the survey linear regression model (to measure how palliative care is associated with healthcare utilization) were used. Results Among 25,121 patients, 50.1% had palliative care during the study period. Survey logistic results showed that patients with higher household income were more likely to receive palliative care than those in lower-income groups. In addition, during hospitalization, receiving palliative care was associated with11.2% lower LOS and 28.4% lower discounted total charges than the non-receiving group. Conclusion Clinical evidence demonstrates the benefits of palliative care as it is associated with efficient end-of-life healthcare utilization. Health policymakers must become aware of the characteristics of receiving the care and the importance of limited healthcare resource allocation as palliative care continues to grow in cancer treatment.
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Affiliation(s)
- Jongwha Chang
- Department of Healthcare Administration, College of Business, Texas Woman's University, Denton, TX, USA
| | - Kyu-Tae Han
- Division of Cancer Control and Policy, National Cancer Center, Goyang, Republic of Korea.,National Hospice Center, National Cancer Center, Goyang, Republic of Korea
| | - Mar Medina
- School of Pharmacy, University of Texas at El Paso, El Paso, TX, USA
| | - Sun Jung Kim
- Department of Healthcare Administration, College of Business, Texas Woman's University, Denton, TX, USA. .,Department of Health Administration and Management, College of Medical Science, Soonchunhyang University, Asan, Republic of Korea. .,Center for Healthcare Management Science, Soonchunhyang University, Asan, Republic of Korea. .,Department of Software Convergence, Soonchunhyang University, Asan, Republic of Korea.
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2
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Engel PT, Thavayogarajah T, Görlich D, Lenz P. Establishment of a Palliative Care Consultation Service (PCCS) in an Acute Hospital Setting. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17144977. [PMID: 32664314 PMCID: PMC7400707 DOI: 10.3390/ijerph17144977] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/01/2020] [Accepted: 07/06/2020] [Indexed: 11/16/2022]
Abstract
Background and study aims: Acute health service requires focused palliative care (PC). This study was performed to provide guidance for the establishment of a palliative care consultation service (PCCS). Patients and methods: This study was conceived as a retrospective single-center study for observing, analyzing and evaluating the initial setup of a PCCS from 1 May 2015 to 31 May 2018. Patients from Muenster University Hospital with advanced life-limiting diseases, identified to require PC, were included. Results: PCCS was requested from various departments, for between 20 and 80 patients per month, corresponding to a total of 2359 for the study period. Requests were highest in internal medicine (27.3%), gynecology (18.1%) and radiotherapy (17.6%). Time to referral was significantly shorter in departments with special PCCS ward rounds (6 ± 9 vs. 12 ± 22 days, p < 0.001). The most frequently reported symptoms were fatigue, pain and loss of appetite. Pain was frequently localized in the stomach (20.4%), back (17.1%), or in the head and neck area (14.9%). After the first PCCS consultation, 254 patients (90%) reported sufficient pain relief after 48 h. An introduction/modification of painkiller medication, which was recommended for 142 inpatients, was implemented in 57.0% of cases by the respective departments. Overall, the direct realization of PCCS recommendations reached only 50% on average. Conclusions: Besides an analysis of the ability to address the symptoms of the referred patients by the PCCS, this study highlights the importance of the interaction between PCCS and other departments. It further elucidates the role and possibilities of this service both in regular ward rounds and individual staff contacts.
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Affiliation(s)
- Peter Tom Engel
- Department of Palliative Care, University of Muenster, 48149 Muenster, Germany;
| | - Tharshika Thavayogarajah
- Department of Hematology, Oncology, Hemostaseology, and Stem Cell Transplantation, Faculty of Medicine, RWTH Aachen University, 52074 Aachen, Germany;
| | - Dennis Görlich
- Institute of Biostatistics and Clinical Research, University of Muenster, 48149 Muenster, Germany;
| | - Philipp Lenz
- Department of Palliative Care, University of Muenster, 48149 Muenster, Germany;
- Correspondence:
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3
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Myers JD. The Role of the Physician Assistant in Hospice and Palliative Medicine. PHYSICIAN ASSISTANT CLINICS 2020. [DOI: 10.1016/j.cpha.2020.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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4
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Mahoney DP, Brook I, Fossa M, Kang T. Attempting to Define Clinical Productivity Metrics among Pediatric Palliative Care Services at Academic Children's Hospitals. J Palliat Med 2020; 23:397-400. [DOI: 10.1089/jpm.2019.0164] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Affiliation(s)
- Daniel P. Mahoney
- Texas Children's Hospital Pediatric Advanced Care Team (PACT), Houston, Texas
| | - Ilanit Brook
- Children's Hospital Los Angeles Comfort and Palliative Care, Los Angeles, California
| | - Mallory Fossa
- Children's Hospital Los Angeles Comfort and Palliative Care, Los Angeles, California
| | - Tammy Kang
- Texas Children's Hospital Pediatric Advanced Care Team (PACT), Houston, Texas
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5
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Dingfield LE, Jackson VA, deLima Thomas J, Doyle KP, Ferris F, Radwany SM. Looking Back, and Ahead: A Call to Action for Increasing the Hospice and Palliative Medicine Specialty Pipeline. J Palliat Med 2020; 23:895-899. [PMID: 32053034 DOI: 10.1089/jpm.2020.0008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Thanks to the efforts of many individuals and organizations, the field of Hospice and Palliative Medicine (HPM) has undergone unprecedented growth over the last two decades. To meet the needs of seriously ill patients and families in inpatient, outpatient community setting in the future, the field of HPM must develop innovative strategies to expand the specialist workforce pipeline. With 148 programs participating in the National Residency Matching Program and 285 matched applicants in 2019, the specialty of HPM can barely replace those who are retiring or leaving the field. We call for a renewed and coordinated effort to increase the applicant pool for HPM fellowship positions, as well as greater access to specialist HPM training through expanded traditional fellowship programs and innovative specialist training pathways. Without such an expansion, our specialty will struggle to serve those patients and families who need us most.
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Affiliation(s)
- Laura E Dingfield
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Vicki A Jackson
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jane deLima Thomas
- Dana Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kathleen P Doyle
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Frank Ferris
- Palliative Care Research and Education, OhioHealth, Columbus, Ohio, USA
| | - Steven M Radwany
- Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA
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Huo J, Hong YR, Turner K, Bian J, Grewal R, Wilkie DJ. Utilization pattern and service settings of palliative care for patients with metastatic non-small cell lung cancer. Cancer 2019; 125:4481-4489. [PMID: 31449674 DOI: 10.1002/cncr.32478] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 07/29/2019] [Accepted: 08/03/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND Although the benefits of palliative care for patients with cancer has been well established, the current utilization pattern remains largely unknown. The authors investigated the temporal trends and service settings of palliative care among Medicare beneficiaries with newly diagnosed, metastatic non-small cell lung cancer (NSCLC). METHODS In total, 69,414 patients with NSCLC were identified between January 1, 2001 and December 31, 2013 from the Surveillance, Epidemiology, and End Results-Medicare-linked database. Temporal trends in palliative care use and the temporal shift in palliative care service settings were assessed using the Cochran-Armitage test. Multivariable logistic regression models were used to identify predictors for the receipt of palliative care, controlling for patients' sociodemographic and clinical characteristics. RESULTS Fifteen percent (10,359) of patients with NSCLC received palliative care within 1 year of a diagnosis of metastatic NSCLC. The proportion of beneficiaries receiving palliative care increased from 3.6% in 2001 to 31.9% in 2013 (P for trend <.001). Multivariable analyses demonstrated that receipt of palliative care varied significantly by sex, race, and region. Most patients (53.5%) had their first receipt of palliative care in a hospital. Less than one-third of patients (27.6%) received palliative care in an outpatient setting or received palliative care in more than 1 service setting (26.3%) in 2013. CONCLUSIONS The number of patients with metastatic NSCLC receiving palliative care has increased substantially. Although the hospital-based program is still the main form of palliative care delivery, more patients in recent years have received palliative care services in multiple locations.
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Affiliation(s)
- Jinhai Huo
- Department of Health Services Research, Management and Policy, College of Public Health and Health Professions, University of Florida, Gainesville, Florida
| | - Young-Rock Hong
- Department of Health Services Research, Management and Policy, College of Public Health and Health Professions, University of Florida, Gainesville, Florida
| | - Kea Turner
- Department of Health Services Research, Management and Policy, College of Public Health and Health Professions, University of Florida, Gainesville, Florida
| | - Jiang Bian
- Department of Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida
| | - Reetu Grewal
- Department of Community Health and Family Medicine, College of Medicine, University of Florida, Jacksonville, Florida
| | - Diana J Wilkie
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, Florida
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7
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Wong A, Vidal M, Prado B, Hui D, Epner M, Balankari VR, De La Cruz VJ, Cantu HP, Zapata KP, Liu DD, Williams JL, Lim T, Bruera E. Patients' Perspective of Timeliness and Usefulness of an Outpatient Supportive Care Referral at a Comprehensive Cancer Center. J Pain Symptom Manage 2019; 58:275-281. [PMID: 31029808 DOI: 10.1016/j.jpainsymman.2019.04.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 04/17/2019] [Accepted: 04/18/2019] [Indexed: 12/25/2022]
Abstract
CONTEXT Current guidelines recommend early referral to palliative care for patients with advanced cancer; however, no studies have examined the optimal timing of referral from the patients' perspective. OBJECTIVES To examine patients' perceptions of timeliness of referral and its association with survival among patients with advanced cancer referred to an outpatient supportive care (SC) clinic. METHODS This cross-sectional prospective study in an SC clinic at a comprehensive cancer center included patients aged 18 years or older with locally advanced, recurrent, or metastatic cancer. Patients were asked to complete an anonymous survey regarding the timeliness and perceived usefulness of SC referral within four weeks of their first SC consultation. RESULTS Of 253 eligible patients, 209 (83%) enrolled in the study and 200 completed the survey. Median survival was 10.3 months. Most patients (72%) perceived that referral occurred "just in time," whereas 21% felt it was "late," and 7% felt "early." A majority (83%) found the referral useful, and 88% would recommend it to other patients with cancer. The perception of being referred early was associated with lower reported levels of pain (P = 0.043), fatigue (P = 0.004), drowsiness (P = 0.005), appetite loss (P = 0.041), poor well-being (P = 0.041), and lower physical (P = 0.001) and overall symptom distress (P = 0.001). No other associations were found between perceived timeliness and usefulness and patients' baseline characteristics. CONCLUSION Most patients with a median survival of 10 months perceived that SC referral was timely and useful. Patient care needs rather than the timing of advanced cancer diagnosis drove this perception of referral timing. Lower symptom burden was associated with the perception of being referred to early.
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Affiliation(s)
- Angelique Wong
- Department of Palliative, Rehabilitation and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
| | - Marieberta Vidal
- Department of Palliative, Rehabilitation and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Bernard Prado
- Department of Oncology and Hematology, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - David Hui
- Department of Palliative, Rehabilitation and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Margeaux Epner
- Department of Palliative, Rehabilitation and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Vishidha Reddy Balankari
- Department of Palliative, Rehabilitation and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Vera J De La Cruz
- Department of Palliative, Rehabilitation and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Hilda P Cantu
- Department of Palliative, Rehabilitation and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Kresnier Perez Zapata
- Department of Palliative, Rehabilitation and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Diane D Liu
- Department of Palliative, Rehabilitation and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Janet L Williams
- Department of Palliative, Rehabilitation and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Taekyu Lim
- Division of Hematology and Oncology, Department of Internal Medicine, Veterans Health Service Medical Center, Seoul, South Korea
| | - Eduardo Bruera
- Department of Palliative, Rehabilitation and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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8
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Prado BL, Haider A, Naqvi S, Pestana RC, Williams JL, Dibaj S, Liu D, Allo J, De La Cruz V, Bruera E. Changes in the Care Setting of First Consults to Palliative and Supportive Care Over a Seven-Year Period. J Pain Symptom Manage 2019; 57:86-92. [PMID: 30315915 DOI: 10.1016/j.jpainsymman.2018.10.269] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 10/01/2018] [Accepted: 10/02/2018] [Indexed: 10/28/2022]
Abstract
CONTEXT Optimal benefits from palliative care (PC) are achieved when first consults (PC1) occur early, in the outpatient setting. Late PC1, like those in the intensive care unit (ICU), limit these benefits. OBJECTIVES The objective of this study was to determine the proportion of PC1 over time in the outpatient, ICU, and inpatient non-ICU settings. We also examined patients' baseline characteristics and the timing of PC access (from PC1 to death) by the setting of PC1. METHODS We retrospectively evaluated consecutive cancer patients' records at our cancer center to ascertain the annual number of PC1 and its distribution across settings (2011-2017). ICU PC1 (n = 309) and a random sample of an equal number of outpatient and inpatient non-ICU PC1 were reviewed to retrieve patients' characteristics and death date. RESULTS PC1 total annual number increased by 58% from 2011 (n = 2286) to 2017 (n = 3615). We found a significant decrease in the proportion of ICU PC1 (from 2.3% in 2011 to 1% in 2017, P < 0.001). There were no significant changes in the proportion of PC1 at outpatient versus inpatient settings (P = 0.2). Hematologic cancer patients were more likely to have an ICU PC1 (P < 0.001). Median survival (months) was 7.7 (6.3-9.7), 3.4 (2.4-4.5), and 0.1 (0.1-0.1) for outpatient, inpatient, and ICU, respectively (P < 0.01). CONCLUSION PC1 total annual number has increased, and the proportion of PC1 at ICU, a very late clinical setting, is decreasing. Further efforts are needed to integrate PC in hematologic cancer care.
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Affiliation(s)
- Bernard L Prado
- Oncology and Hematology Department, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Ali Haider
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Syed Naqvi
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Roberto C Pestana
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Janet L Williams
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Seyedeh Dibaj
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Diane Liu
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Julio Allo
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Vera De La Cruz
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Eduardo Bruera
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
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9
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Integration of oncology and palliative care: a Lancet Oncology Commission. Lancet Oncol 2018; 19:e588-e653. [DOI: 10.1016/s1470-2045(18)30415-7] [Citation(s) in RCA: 297] [Impact Index Per Article: 49.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 05/16/2018] [Accepted: 05/22/2018] [Indexed: 02/06/2023]
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10
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Hui D, Hannon B, Zimmermann C, Bruera E. Improving patient and caregiver outcomes in oncology: Team-based, timely, and targeted palliative care. CA Cancer J Clin 2018; 68:356-376. [PMID: 30277572 PMCID: PMC6179926 DOI: 10.3322/caac.21490] [Citation(s) in RCA: 218] [Impact Index Per Article: 36.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Over the past decade, a large body of evidence has accumulated supporting the integration of palliative care into oncology practice for patients with advanced cancer. The question is no longer whether palliative care should be offered, but what is the optimal model of delivery, when is the ideal time to refer, who is in greatest need of a referral, and how much palliative care should oncologists themselves be providing. These questions are particularly relevant given the scarcity of palliative care resources internationally. In this state-of-the-science review directed at the practicing cancer clinician, the authors first discuss the contemporary literature examining the impact of specialist palliative care on various health outcomes. Then, conceptual models are provided to support team-based, timely, and targeted palliative care. Team-based palliative care allows the interdisciplinary members to address comprehensively the multidimensional care needs of patients and their caregivers. Timely palliative care, at its best, is preventive care to minimize crises at the end of life. Targeted palliative care involves identifying the patients most likely to benefit from specialist palliative care interventions, akin to the concept of targeted cancer therapies. Finally, the strengths and weaknesses of innovative care models, such as outpatient clinics, embedded clinics, nurse-led palliative care, primary palliative care provided by oncology teams, and automatic referral, are summarized. Moving forward, more research is needed to determine how different health systems can best personalize palliative care to provide the right level of intervention, for the right patient, in the right setting, at the right time. CA Cancer J Clin. 2018;680:00-00. 2018 American Cancer Society, Inc.
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Affiliation(s)
- David Hui
- Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Breffni Hannon
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Camilla Zimmermann
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Eduardo Bruera
- Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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11
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Lim CT, Tadmor A, Fujisawa D, MacDonald JJ, Gallagher ER, Eusebio J, Jackson VA, Temel JS, Greer JA, Hagan T, Park ER. Qualitative Research in Palliative Care: Applications to Clinical Trials Work. J Palliat Med 2017; 20:857-861. [PMID: 28388341 DOI: 10.1089/jpm.2017.0061] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND While vast opportunities for using qualitative methods exist within palliative care research, few studies provide practical advice for researchers and clinicians as a roadmap to identify and utilize such opportunities. OBJECTIVE To provide palliative care clinicians and researchers descriptions of qualitative methodology applied to innovative research questions relative to palliative care research and define basic concepts in qualitative research. Body: We describe three qualitative projects as exemplars to describe major concepts in qualitative analysis of early palliative care: (1) a descriptive analysis of clinician documentation in the electronic health record, (2) a thematic content analysis of palliative care clinician focus groups, and (3) a framework analysis of audio-recorded encounters between patients and clinicians as part of a clinical trial. CONCLUSIONS This study provides a foundation for undertaking qualitative research within palliative care and serves as a framework for use by other palliative care researchers interested in qualitative methodologies.
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Affiliation(s)
| | - Avia Tadmor
- 2 Harvard College , Cambridge, Massachusetts
| | - Daisuke Fujisawa
- 3 Massachusetts General Hospital Cancer Center , Boston, Massachusetts.,4 National Cancer Center Hospital East , Kashiwa, Chiba, Japan .,5 Department of Neuropsychiatry, Keio University School of Medicine , Tokyo, Japan
| | - James J MacDonald
- 3 Massachusetts General Hospital Cancer Center , Boston, Massachusetts
| | - Emily R Gallagher
- 3 Massachusetts General Hospital Cancer Center , Boston, Massachusetts
| | - Justin Eusebio
- 3 Massachusetts General Hospital Cancer Center , Boston, Massachusetts
| | - Vicki A Jackson
- 1 Harvard Medical School , Boston, Massachusetts.,3 Massachusetts General Hospital Cancer Center , Boston, Massachusetts
| | - Jennifer S Temel
- 1 Harvard Medical School , Boston, Massachusetts.,3 Massachusetts General Hospital Cancer Center , Boston, Massachusetts
| | - Joseph A Greer
- 1 Harvard Medical School , Boston, Massachusetts.,3 Massachusetts General Hospital Cancer Center , Boston, Massachusetts
| | | | - Elyse R Park
- 1 Harvard Medical School , Boston, Massachusetts.,3 Massachusetts General Hospital Cancer Center , Boston, Massachusetts
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12
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Dalal S, Bruera E. End-of-Life Care Matters: Palliative Cancer Care Results in Better Care and Lower Costs. Oncologist 2017; 22:361-368. [PMID: 28314840 PMCID: PMC5388382 DOI: 10.1634/theoncologist.2016-0277] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 01/13/2017] [Indexed: 12/25/2022] Open
Abstract
This article reviews the current state of end‐of‐life care, analyzes the clinical and financial impact of palliative care, and proposes areas of future research and development.
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Affiliation(s)
- Shalini Dalal
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Eduardo Bruera
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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13
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14
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Dalal S, Bruera S, Hui D, Yennu S, Dev R, Williams J, Masoni C, Ihenacho I, Obasi E, Bruera E. Use of Palliative Care Services in a Tertiary Cancer Center. Oncologist 2015; 21:110-8. [PMID: 26614711 PMCID: PMC4709207 DOI: 10.1634/theoncologist.2015-0234] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 09/23/2015] [Indexed: 12/25/2022] Open
Abstract
This study analyzed palliative/supportive care use in a single cancer center over 8 years. Billing data showed the inpatient consultations as a percentage of hospital admissions and the ratio of inpatient consultations to hospital beds almost doubled. In the outpatient setting, data revealed earlier access to outpatient referrals to palliative care service (from 4.8 months to 7.9 months; p = .001) during the study period. Background. Despite increasing prevalence of palliative care (PC) services in cancer centers, most referrals to the service occur exceedingly late in the illness trajectory. Over the years, we have made several attempts to promote earlier patient access to our PC program, such as changing the name of our service from PC to supportive care (SC). This study was conducted to determine the use of PC/SC service over the past 8 years. Methods. We reviewed billing data for all PC/SC encounters. We examined five metrics for use: inpatient consultations as a percentage of hospital admissions, ratio of inpatient consultations to average number of operational beds, time from hospital registration to outpatient consultation, time from advanced cancer diagnosis to consultation, and time from first outpatient consultation to death/last follow-up. Results. Over the years, we found a consistent increase in patient referrals to the PC/SC program. In the inpatient setting, we found approximate doubling of the inpatient consultations as a percentage of hospital admissions and the ratio of inpatient consultations to hospital beds (from 10% to 19% and from 2.4 to 4.9, respectively; p < .001). In the outpatient setting, we observed variations in referral pattern between oncology services, but, overall, the time from consultation to death/last follow-up increased from 4.8 months to 7.9 months (p = .001), which was accompanied by a significant decrease in the interval to consultation from hospital registration and advanced cancer diagnosis (p < .001). Conclusion. We have observed a consistent annual increase in new patient referrals as well as earlier access for outpatient referrals to our SC service, supporting increased use of palliative care at our cancer center. Implications for Practice: In response to accumulating evidence on the benefits of palliative care (PC) referral to oncology patients, efforts are being made to increase PC use. This study, conducted at MD Anderson Cancer Center, demonstrates consistent annual growth in PC referrals, which was accompanied by a significant increase in the outpatient referral of patients with nonadvanced cancer and earlier referral of those with advanced cancer. However, significant variations in the referral patterns between oncology services were observed. These results have implications for other cancer centers looking to enhance use of PC services by having a business model that allows for appropriate space and staff expansion.
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Affiliation(s)
- Shalini Dalal
- Department of Palliative Care and Rehabilitation Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sebastian Bruera
- Department of Internal Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - David Hui
- Department of Palliative Care and Rehabilitation Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sriram Yennu
- Department of Palliative Care and Rehabilitation Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Rony Dev
- Department of Palliative Care and Rehabilitation Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Janet Williams
- Department of Palliative Care and Rehabilitation Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Charles Masoni
- Department of Palliative Care and Rehabilitation Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ijeoma Ihenacho
- Department of Palliative Care and Rehabilitation Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Emmanuel Obasi
- Department of Palliative Care and Rehabilitation Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Eduardo Bruera
- Department of Palliative Care and Rehabilitation Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Kim YJ, Hui D, Zhang Y, Park JC, Chisholm G, Williams J, Bruera E. Differences in Performance Status Assessment Among Palliative Care Specialists, Nurses, and Medical Oncologists. J Pain Symptom Manage 2015; 49:1050-1058.e2. [PMID: 25542550 DOI: 10.1016/j.jpainsymman.2014.10.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Revised: 10/26/2014] [Accepted: 11/13/2014] [Indexed: 10/24/2022]
Abstract
CONTEXT The Eastern Cooperative Oncology Group performance status (ECOG PS) is one of the most commonly used assessments in oncology and palliative care (PC). However, the interobserver differences between medical oncologists and PC specialists have never been reported. OBJECTIVES To determine the interobserver differences in ECOG PS assessment among PC specialists, PC nurses, and medical oncologists in patients with advanced cancer. METHODS We retrospectively reviewed the medical records of all patients who had an outpatient PC consultation in 2013 and identified 278 eligible patients. We retrieved the ECOG PS scores and symptom burden assessed by the Edmonton Symptom Assessment System (ESAS). RESULTS PC specialists (median +0.5, P < 0.0001) and nurses (median +1.0, P < 0.0001) rated the ECOG PS significantly higher than medical oncologists. The weighted kappa values were 0.26 between PC specialists and medical oncologists and 0.61 between PC specialists and nurses. PC specialists' assessments correlated with ESAS fatigue, dyspnea, anorexia, feeling of well-being, and symptom distress score. The ECOG PS assessments by all three groups were significantly associated with survival (P < 0.001). However, patients with ECOG PS 2 and 3-4 rated by their medical oncologists had similar survival (P = 0.67). Predictors of discordance in ECOG PS assessments between PC specialists and medical oncologists were the presence of a potentially effective treatment (odds ratio [OR] 2.39; 95% CI 1.09-5.23) and poor feeling of well-being (≥4) (OR 2.38, 95% CI 1.34-4.21). CONCLUSION ECOG PS assessments by PC specialists and nurses were significantly higher than those of medical oncologists. Systematic efforts to increase regular interdisciplinary communications may help to bridge this gap.
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Affiliation(s)
- Yu Jung Kim
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA; Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - David Hui
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Yi Zhang
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA; Department of Medical Oncology, Shanghai University of Traditional Chinese Medicine, Shuguang Hospital, Shanghai, China
| | - Ji Chan Park
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA; Division of Hematology-Oncology, Department of Internal Medicine, Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, Republic of Korea
| | - Gary Chisholm
- Department of Biostatistics, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Janet Williams
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Eduardo Bruera
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA.
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Pimentel LE, Yennurajalingam S, Chisholm G, Edwards T, Guerra-Sanchez M, De La Cruz M, Tanco K, Vidal M, Bruera E. The frequency and factors associated with the use of a dedicated Supportive Care Center Telephone Triaging Program in patients with advanced cancer at a comprehensive cancer center. J Pain Symptom Manage 2015; 49:939-44. [PMID: 25666520 DOI: 10.1016/j.jpainsymman.2014.10.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Revised: 10/13/2014] [Accepted: 10/22/2014] [Indexed: 01/30/2023]
Abstract
CONTEXT There is limited literature on characteristics of telephone triage programs and the nature of interventions in palliative care. OBJECTIVES Our aim was to determine frequency and type of care provided by a Supportive Care Center Telephone Triaging Program (SCCTP) in advanced cancer patients (ACPs). METHODS Electronic medical records were reviewed of 400 consecutive ACPs referred to palliative care at a comprehensive cancer center and given access to the SCCTP: 200 from the outpatient (OP) supportive care center and 200 from inpatient (IP) palliative care given access after discharge. We reviewed call frequency, type, reason, and outcomes including pain and other symptoms (Edmonton Symptom Assessment Scale and Memorial Delirium Assessment Scale [MDAS]) associated with utilization of the SCCTP. RESULTS A total of 375 patients were evaluable. One hundred fifteen of 400 patients (29%) used the SCCTP: 96 OPs (83%) used the SCCTP vs. only 19 IPs (17%) (P < 0.001). The most common reasons for calls were pain (24%), pain medication refills (24%), and counseling (12%). For 115 phone calls, 43% (145 of 340) of recommendations were regarding care at home and 56% were regarding opioids. Patients who used the SCCTP had worse pain (P = 0.006), fatigue (P = 0.045), depression (P = 0.041), and well-being (P = 0.015) and better MDAS scores (P = 0.014) compared with nonusers. OPs had a higher prevalence of symptom distress (P = 0.013), depression (P < 0.001), anxiety (P < 0.01), and insomnia scores (P = 0.001); MDAS scores were significantly higher in IPs (P < 0.001). CONCLUSION In this study, we found that overall utilization of the SCCTP by ACPs referred to palliative care was relatively low at 28.7%. The use of the SCCTP was particularly poor among the IPs on discharge. Patients who used SCCTP had worse pain, fatigue, depression, and well-being scores and better delirium scores.
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Affiliation(s)
- Lindsey E Pimentel
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Sriram Yennurajalingam
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Gary Chisholm
- Department of Biostatistics, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Tonya Edwards
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Maria Guerra-Sanchez
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Maxine De La Cruz
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Kimberson Tanco
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Marieberta Vidal
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Eduardo Bruera
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA.
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Heedman PA, Canslätt E, Henriks G, Starkhammar H, Fomichov V, Sjödahl R. Variation at presentation among colon cancer patients with metastases: a population-based study. Colorectal Dis 2015; 17:403-8. [PMID: 25511984 DOI: 10.1111/codi.12864] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 10/08/2014] [Indexed: 01/03/2023]
Abstract
AIM The study aimed to describe and follow a 2 year cohort of colon cancer patients with Stage IV disease from presentation to long-term outcome. METHOD The records of 177 colon cancer patients diagnosed in southeast Sweden during 2009-2010 with disseminated disease at presentation were reviewed retrospectively. RESULTS The patients were heterogeneous with respect to age, performance status and survival. Despite metastatic disease, local symptoms from the primary tumour dominated the initial clinical picture. Forty-one per cent had anaemia. The time from suspicion of colon cancer to established diagnosis of disseminated disease varied from 0 to 231 days (emergency cases included, median 12 days). The majority (77%) were diagnosed in hospital. In 53% the primary tumour and the metastases were not diagnosed on the same occasion which may increase the risk for misinformation or delays in the care process. The possibility of simultaneous diagnosis was doubled when the patient was investigated as an inpatient. Patients were seen by one to 12 physicians (median three) in the investigation phase, and one to 47 (median 11) from diagnosis until the last record in the hospital notes. The 1-year survival was 46%. CONCLUSION Patients with metastatic colon cancer at presentation are heterogeneous and warrant an adapted multidisciplinary approach to achieve the goal of individualized treatment for each patient in accordance with the Swedish national cancer strategy.
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Affiliation(s)
- P A Heedman
- Palliative Education and Research Center, Östergötland, Sweden; Regional Cancer Centre, Linköping, Sweden
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Abstract
Pediatric palliative care (PPC) is a relatively new and quickly growing pediatric subspecialty. It is generally provided using a consultative model, and is available in most specialized pediatric hospitals. This article discusses PPC consultation with specific focus on the added value of PPC, elements of a PPC consultation, and challenges to and opportunities for PPC consultation. Ongoing research, current publication, expert opinion, and institutional experience were compiled for this article.
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Affiliation(s)
- Dominic Moore
- Division of In-Patient Medicine, Pediatrics, Primary Children's Hospital, University of Utah, 100 North Mario Capecchi Drive, Salt Lake City, UT 84113, USA
| | - Joan Sheetz
- Division of In-Patient Medicine, Pediatrics, Primary Children's Hospital, University of Utah, 100 North Mario Capecchi Drive, Salt Lake City, UT 84113, USA.
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Feudtner C, Womer J, Augustin R, Remke S, Wolfe J, Friebert S, Weissman D. Pediatric palliative care programs in children's hospitals: a cross-sectional national survey. Pediatrics 2013; 132:1063-70. [PMID: 24190689 DOI: 10.1542/peds.2013-1286] [Citation(s) in RCA: 180] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Pediatric palliative care (PPC) programs facilitate the provision of comprehensive care to seriously ill children. Over the past 10 years many such programs have been initiated by children's hospitals, but little is known about their number, staff composition, services offered, sources of support, or national distribution. METHODS In the summer of 2012, we surveyed 226 hospitals as identified by the National Association of Children's Hospitals and Related Institutions. The survey instrument gathered data about whether their institution had a PPC program, and for hospitals with programs, it asked for a wide range of information including staffing, patient age range, services provided, and financial support. RESULTS Of the 162 hospitals that provided data (71.7% response rate), 69% reported having a PPC program. The rate of new program creation peaked in 2008, with 12 new programs created that year, and 10 new programs in 2011. Most programs offer only inpatient services, and most only during the work week. The number of consults per year varied substantially across programs, and was positively associated with hospital bed size and number of funded staff members. PPC programs report a high level of dependence on hospital funding. CONCLUSIONS PPC programs are becoming common in children's hospitals throughout the United States yet with marked variation in how these programs are staffed, the level of funding for staff effort to provide PPC, and the number of consultations performed annually. Guidelines for PPC team composition, funding, and consultation standards may be warranted to ensure the highest quality of PPC.
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Affiliation(s)
- Chris Feudtner
- CHOP North, Room 1523, The Children's Hospital of Philadelphia, 34th and Civic Center Blvd, Philadelphia, PA 10194.
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Abstract
BACKGROUND In the last 25 years, palliative care has made major progress as an interdisciplinary specialty that addresses quality-of-life issues for patients with life-limiting illnesses and their families. Research by numerous investigators has contributed to our increasing body of knowledge to support an evidence-based practice. AIM We highlight some lessons learned by our group in the process of conducting palliative care research, focusing in particular on symptom assessment; the management of pain, fatigue, cachexia, dyspnea, delirium, and opioid-induced neurotoxicity; and outcomes of our palliative care program. DESIGN Narrative review of selected literature, focusing on studies conducted by our group. DATA SOURCES This article is based on the Second Vittorio Ventafridda Memorial Lecture by Dr Eduardo Bruera, delivered at the European Association for Palliative Care, Trondheim, Norway on 8 June 2012. RESULTS For each topic, we review some of the pivotal studies in palliative care, discuss the challenges in research design, and outline possible directions for future research. CONCLUSIONS We conclude by sharing some of what we learned about the processes, pearls, and pitfalls of palliative care research.
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Affiliation(s)
- Eduardo Bruera
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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