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Dharmarajan KV, Walters CB, Levin TT, Milazzo CA, Monether C, Rawlins-Duell R, Tickoo R, Spratt DE, Lovie S, Giannantoni-Ibelli G, McCormick B. A Video Decision Aid Improves Informed Decision Making in Patients With Advanced Cancer Considering Palliative Radiation Therapy. J Pain Symptom Manage 2019; 58:1048-1055.e2. [PMID: 31472276 PMCID: PMC8132595 DOI: 10.1016/j.jpainsymman.2019.08.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 08/07/2019] [Accepted: 08/09/2019] [Indexed: 12/16/2022]
Abstract
CONTEXT Advanced cancer patients have unrecognized gaps in their understanding about palliative radiation therapy (PRT). OBJECTIVES To build a video decision aid for hospitalized patients with advanced cancer referred for PRT and prospectively test its efficacy in reducing decisional uncertainty, improving knowledge, increasing treatment readiness and readiness for palliative care consultation, and its acceptability among patients. METHODS Forty patients with advanced cancer hospitalized at Memorial Sloan Kettering Cancer Center watched a video decision aid about PRT and palliative care. Patients' conceptual and logistical knowledge of PRT, decisional uncertainty, treatment readiness, and readiness for palliative care consultation were assessed before and after watching the video with a six-item knowledge survey, the decisional uncertainty subscale of the Decisional Conflict Scale, and Likert instruments to assess readiness to accept radiation treatment and/or palliative care consultation, respectively. A postvideo survey assessed the video's acceptability among patients. RESULTS After watching the video, decisional uncertainty was reduced (28.3 vs. 21.7; P = 0.02), knowledge of PRT improved (60.4 vs. 88.3; P < 0.001), and PRT readiness increased (2.0 vs. 1.3; P = 0.04). Readiness for palliative care consultation was unchanged (P = 0.58). Patients felt very comfortable (70%) watching the video and would highly recommend it (75%) to others. CONCLUSION Among hospitalized patients with advanced cancer, a video decision aid reduced decisional uncertainty, improved knowledge of PRT, increased readiness for PRT, and was well received by patient viewers.
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Affiliation(s)
- Kavita V Dharmarajan
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
| | - Chasity B Walters
- Department of Patient & Caregiver Education, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Tomer T Levin
- Department of Psychiatry, Weill Cornell Psychiatry Collaborative Care Center, Weill Cornell Medicine, New York, New York, USA
| | - Carol Ann Milazzo
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | | | - Robin Rawlins-Duell
- Division of Pain and Palliative Care, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Roma Tickoo
- Division of Pain and Palliative Care, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Daniel E Spratt
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Shona Lovie
- The Leukemia & Lymphoma Society, New York, New York, USA
| | - Gina Giannantoni-Ibelli
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Beryl McCormick
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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Moryl N, Dave V, Glare P, Bokhari A, Malhotra VT, Gulati A, Hung J, Puttanniah V, Griffo Y, Tickoo R, Wiesenthal A, Horn SD, Inturrisi CE. Patient-Reported Outcomes and Opioid Use by Outpatient Cancer Patients. J Pain 2018; 19:278-290. [PMID: 29154919 PMCID: PMC5811357 DOI: 10.1016/j.jpain.2017.11.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Revised: 10/23/2017] [Accepted: 11/03/2017] [Indexed: 11/21/2022]
Abstract
The Memorial Sloan Kettering Pain Registry contains patient characteristics, treatments, and outcomes for a prospective cohort of 1,534 chronic pain cancer patients who were seen at outpatient pain service clinics. Average pain intensity (Brief Pain Inventory) was reported as mild by 24.6% of patients, moderate by 41.5%, and severe by 33.9%. The patient's report of average percent pain relief and health state (EuroQOL 5 dimensions) was inversely related to average pain intensity category, whereas measures of pain interference, number of worst pain locations, and physical and psychological distress were directly related to pain intensity category. Eighty-six percent of patients received an opioid at 1 or more clinic encounters. Regression analysis revealed that male sex or being younger (65 years of age or younger) was associated with a greater likelihood of an opioid ordered. Male sex nearly doubled the likelihood of a higher dose being ordered than female sex. Bivariate analysis found that patients receiving opioids reported significantly more pain relief than no-opioid patients. However, patients receiving opioids had higher pain interference scores, lower index of health state, and more physical distress than no-opioid patients Our results identify the need to consider opioid use and dosage when attempting to understand patient-reported outcomes (PROs) and factors affecting pain management. PERSPECTIVE This report describes the results of the analyses of PROs and patient-related electronic health record data collected under standard of care from cancer patients at outpatient pain management clinics of Anesthesiology and Palliative Care at the Memorial Sloan Kettering Cancer Center. Consideration of sex and age as predictors of opioid use is critical in attempting to understand PROs and their relationship to pain management.
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Affiliation(s)
- Natalie Moryl
- Palliative Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Vinnidhy Dave
- Palliative Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Paul Glare
- Palliative Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ali Bokhari
- Palliative Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Vivek T Malhotra
- Anesthesia Pain Services, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Amitabh Gulati
- Anesthesia Pain Services, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Joseph Hung
- Anesthesia Pain Services, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Vinay Puttanniah
- Anesthesia Pain Services, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Yvona Griffo
- Palliative Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Roma Tickoo
- Palliative Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Alison Wiesenthal
- Palliative Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Susan D Horn
- Health System Innovation and Research Division, University of Utah School of Medicine, Salt Lake City, Utah
| | - Charles E Inturrisi
- Palliative Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Pharmacology, Weill Cornell Medical College, New York, New York.
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Dans M, Smith T, Back A, Baker JN, Bauman JR, Beck AC, Block S, Campbell T, Case AA, Dalal S, Edwards H, Fitch TR, Kapo J, Kutner JS, Kvale E, Miller C, Misra S, Mitchell W, Portman DG, Spiegel D, Sutton L, Szmuilowicz E, Temel J, Tickoo R, Urba SG, Weinstein E, Zachariah F, Bergman MA, Scavone JL. NCCN Guidelines Insights: Palliative Care, Version 2.2017. J Natl Compr Canc Netw 2017; 15:989-997. [DOI: 10.6004/jnccn.2017.0132] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Levy M, Smith T, Alvarez-Perez A, Back A, Baker JN, Beck AC, Block S, Dalal S, Dans M, Fitch TR, Kapo J, Kutner JS, Kvale E, Misra S, Mitchell W, Portman DG, Sauer TM, Spiegel D, Sutton L, Szmuilowicz E, Taylor RM, Temel J, Tickoo R, Urba SG, Weinstein E, Zachariah F, Bergman MA, Scavone JL. Palliative Care Version 1.2016. J Natl Compr Canc Netw 2016; 14:82-113. [PMID: 26733557 DOI: 10.6004/jnccn.2016.0009] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The NCCN Guidelines for Palliative Care provide interdisciplinary recommendations on palliative care for patients with cancer. The NCCN Guidelines are intended to provide guidance to the primary oncology team on the integration of palliative care into oncology. The NCCN Palliative Care Panel's recommendations seek to ensure that each patient experiences the best quality of life possible throughout the illness trajectory. Accordingly, the NCCN Guidelines outline best practices for screening, assessment, palliative care interventions, reassessment, and after-death care.
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Dave V, Roberts R, Griffo Y, Moryl N, Tickoo R, Cubert K, Gulati A, Hung J, Puttanniah V, Horn S, Brown P, Malhotra V, Glare PA, Inturrisi C. Association of severe pain with poor response to opioids, psychological distress, and aberrant drug taking behaviors in a large cohort of cancer patients. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.9600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Vinnidhy Dave
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ria Roberts
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Yvona Griffo
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Natalie Moryl
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Roma Tickoo
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | - Joseph Hung
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Susan Horn
- International Severity Information Systems, Salt Lake City, UT
| | - Patrick Brown
- International Severity Information Systems, Salt Lake City, UT
| | | | - Paul A. Glare
- Memorial Sloan Kettering Cancer Center, New York, NY
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Levy MH, Smith T, Alvarez-Perez A, Back A, Baker JN, Block S, Codada SN, Dalal S, Dans M, Kutner JS, Kvale E, Misra S, Mitchell W, Sauer TM, Spiegel D, Sutton L, Taylor RM, Temel J, Tickoo R, Urba SG, Van Zyl C, Weinstein SM, Bergman MA, Scavone JL. Palliative Care, Version 1.2014. J Natl Compr Canc Netw 2014; 12:1379-88. [DOI: 10.6004/jnccn.2014.0136] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Levy MH, Adolph MD, Back A, Block S, Codada SN, Dalal S, Deshields TL, Dexter E, Dy SM, Knight SJ, Misra S, Ritchie CS, Sauer TM, Smith T, Spiegel D, Sutton L, Taylor RM, Temel J, Thomas J, Tickoo R, Urba SG, Von Roenn JH, Weems JL, Weinstein SM, Freedman-Cass DA, Bergman MA. Palliative care. J Natl Compr Canc Netw 2013; 10:1284-309. [PMID: 23054879 DOI: 10.6004/jnccn.2012.0132] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
These guidelines were developed and updated by an interdisciplinary group of experts based on clinical experience and available scientific evidence. The goal of these guidelines is to help patients with cancer experience the best quality of life possible throughout the illness trajectory by providing guidance for the primary oncology team for symptom screening, assessment, palliative care interventions, reassessment, and afterdeath care. Palliative care should be initiated by the primary oncology team and augmented by collaboration with an interdisciplinary team of palliative care experts.
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Abstract
Nausea and vomiting are portrayed in the specialist palliative care literature as common and distressing symptoms affecting the majority of patients with advanced cancer and other life-limiting illnesses. However, recent surveys indicate that these symptoms may be less common and bothersome than has previously been reported. The standard palliative care approach to the assessment and treatment of nausea and vomiting is based on determining the cause and then relating this back to the "emetic pathway" before prescribing drugs such as dopamine antagonists, antihistamines, and anticholinergic agents which block neurotransmitters at different sites along the pathway. However, the evidence base for the effectiveness of this approach is meager, and may be in part because relevance of the neuropharmacology of the emetic pathway to palliative care patients is limited. Many palliative care patients are over the age of 65 years, making these agents difficult to use. Greater awareness of drug interactions and QT(c) prolongation are emerging concerns for all age groups. The selective serotonin receptor antagonists are the safest antiemetics, but are not used first-line in many countries because there is very little scientific rationale or clinical evidence to support their use outside the licensed indications. Cannabinoids may have an increasing role. Advances in interventional gastroenterology are increasing the options for nonpharmacological management. Despite these emerging issues, the approach to nausea and vomiting developed within palliative medicine over the past 40 years remains relevant. It advocates careful clinical evaluation of the symptom and the person suffering it, and an understanding of the clinical pharmacology of medicines that are available for palliating them.
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Affiliation(s)
- Paul Glare
- Pain and Palliative Care Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
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Glare PA, Plakovic MK, Griffo Y, Moryl N, Stabler SM, Tickoo R, Norona S, Stenson B, Egan B, Thaler HT, Kelsen DP. Fast-tracking palliative care consults: Pilot implementation of National Comprehensive Cancer Network (NCCN) palliative care screening and referral guideline. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e19636] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Watve MG, Tickoo R, Jog MM, Bhole BD. How many antibiotics are produced by the genus Streptomyces? Arch Microbiol 2001; 176:386-90. [PMID: 11702082 DOI: 10.1007/s002030100345] [Citation(s) in RCA: 497] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2001] [Accepted: 08/14/2001] [Indexed: 11/27/2022]
Abstract
Streptomyces is the largest antibiotic-producing genus in the microbial world discovered so far. The number of antimicrobial compounds reported from the species of this genus per year increased almost exponentially for about two decades, followed by a steady rise to reach a peak in the 1970s, and with a substantial decline in the late 1980s and 1990s. The cumulative number shows a sigmoid curve that is much flatter than what a logistic equation would predict. We attempted to fit a mathematical model to this curve in order to estimate the number of undiscovered antimicrobials from this genus as well as to predict the trends in the near future. A model assuming that the screening efforts are encouraged by a previous year's success and that the probability of finding a new antibiotic is a function of the fraction of antibiotics undiscovered so far offered a good fit after optimizing parameters. The model estimated the total number of antimicrobial compounds that this genus is capable of producing to be of the order of a 100,000 - a tiny fraction of which has been unearthed so far. The decline in the slope appeared to be due to a decline in screening efforts rather than an exhaustion of compounds. Left to itself, the slope will become zero in the next one or two decades, but if the screening efforts are maintained constant, the rate of discovery of new compounds will not decline for several decades to come.
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Affiliation(s)
- M G Watve
- Department of Microbiology, Abasaheb Garware College, Pune 411 004, India.
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Abstract
Acute Respiratory Infections (ARIs) account for a very high morbidity and mortality amongst children in the developing countries. A knowledge, attitude and practice study in relation to the literacy status of mothers whose children suffered from ARI was conducted. A sample of 140 mothers who had 265 children were selected for the study. The majority of literate mothers (75%) had complete knowledge regarding management of ARI. Literacy alone was not the only factor responsible for developing a positive attitude and adopting correct practices during ARI. Mass media and health personnel played an equally important role. Most women (89.3%) had obtained their knowledge regarding ARI through media and paramedical staff. Most mothers (96.4%) were concerned about the health of their children when they suffered from episodes of ARI and the majority of them (87.2%) were worried because they felt that their children or contacts could be adversely affected. Nearly 72% of mothers took early action during an episode of ARI. The majority of the medical practitioners practised non-allopathic medicine but all of them were prescribing allopathic drugs. Most of the mothers (70%) had no problem in taking their children to the desired health centers when needed.
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Affiliation(s)
- A Z Khan
- Department of Community Medicine, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh
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