PC-FACS

Abstract

PC-FACS (Fast Article Critical Summaries for Clinicians in Palliative Care) provides hospice and palliative care clinicians with concise summaries of the most important findings from more than 100 medical and scientific journals. If you have colleagues who would benefit from receiving PCFACS, please encourage them to join the AAHPM at aahpm.org. Comments from readers are welcomed at [email protected] . PC-FACS (Fast Article Critical Summaries for Clinicians in Palliative Care) provides hospice and palliative care clinicians with concise summaries of the most important findings from more than 100 medical and scientific journals. If you have colleagues who would benefit from receiving PCFACS, please encourage them to join the AAHPM at aahpm.org. Comments from readers are welcomed at [email protected] . Patient-Physician Communication Batten JN, Wong BO, Hanks WF, Magnus DC. Treatability statements in serious illness: the gap between what is said and what is heard. Camb Q Healthc Ethics. 2019;28(3):394-404. Sacks CA, Miller PW, Longo DL. Talking about toxicity—“what we’ve got here is a failure to communicate.” N Engl J Med. 2019;381(15):1406-1408. Palliative Care in Different Cultures Shabnam J, Timm H, Nielsen DS, Raunkiaer M. Palliative care for older South Asian migrants: a systematic review. Palliat Support Care. 2019:1-13. Decision Making Based on Patient Priorities Tinetti ME, Naik AD, Dindo L, et al. Association of patient priorities–aligned decision-making with patient outcomes and ambulatory health care burden among older adults with multiple chronic conditions: a nonrandomized clinical trial [published online ahead of print October 7, 2019]. JAMA Intern Med. https://doi.org/10.1001/jamainternmed.2019.4235. End-of-Life Care Resources Ashana DC, Umscheid CA, Stephens-Shields AJ, et al. Determining the association between end-of-life care resources and patient outcomes in Pennsylvania ICUs. Crit Care Med. 2019;47(11):1591-1598. Resilience Among Families with Cancer Rosenberg AR, Bradford MC, Junkins CC, et al. Effect of the promoting resilience in stress management intervention for parents of children with cancer (PRISM-P): a randomized clinical trial. JAMA Netw Open. 2019;2(9):e1911578. Lau N, Yi-Frazier JP, Bona K, Baker KS, McCauley E, Rosenberg A. Distress and resilience among adolescents and young adults with cancer and their mothers: an exploratory analysis [published online ahead of print August 28, 2019]. J Psychosoc Oncol. 1-7. https://doi.org/10.1080/07347332.2019.1656317. Support in Advance Care Planning Cruz-Oliver DM, Tseng TY, Mitchell MM, et al. Support network factors associated with naming a health care decision-maker and talking about advance care planning among people living with human immunodeficiency virus [published online ahead of print August 22, 2019]. J Pain Symptom Manage. pii: S0885-3924(19)30505-6. https://doi.org/10.1016/j.jpainsymman.2019.08.019. Opioid Combination Therapy Haider A, Azhar A, Nguyen K, et al. Concurrent use of opioids with benzodiazepines or nonbenzodiazepine sedatives among patients with cancer referred to an outpatient palliative care clinic [published online ahead of print August 28, 2019]. Cancer. https://doi.org/10.1002/cncr.32484. Rave Reviews Divergent understandings of treatability statements (TSs) and treatment side effects may impair communication with patients with critical illness.1,2 How can the medical community communicate more clearly with seriously ill patients? This paper sought to better understand the divergence in physician-patient understandings about TSs in the context of serious illness through linguistic theory—particularly, H.P. Grice’s concept of conversational implicature. First, TSs were clarified as a phenomenon for study by situating them in a clinical case and defining the multiple levels of meaning they may convey. Second, theoretical work in pragmatics (what words convey in particular contexts) was mobilized to explain how TSs come to have such divergent meanings in this context. Three levels of meaning of TSs were revealed: the literal meaning, the physician’s intended meaning, and the patient’s received meaning. Differences between intended and received meanings: physicians primarily are concerned with clarifying goals of treatment, but patients primarily are concerned with prognosis; intended meaning is framed in technical terms relevant for the physician’s work, but received meaning is framed in everyday terms relevant for to patient’s life/experience; and intended meaning is neutral regarding treatment efficacy/impact, but received meaning assumes treatment effectiveness/helpfulness. The divergence between intended meaning and received meaning can be understood to arise from the lack of shared experience between physicians and patients and the differing assumptions that each party makes about conversations. This perspective article discussed how investigators might communicate with clinicians openly and specifically about treatment risks/benefits, instead of filling medical journals with vague language⁠—underplaying the complexity inherent in using potent treatments. A phrase like “generally well tolerated” can mean very different things to different reasonable people. When investigators refer to a toxic effect as “manageable” or a treatment as “well tolerated,” they usually are attempting to convey 1 of 3 scenarios: 1) Many/most people may have experienced mild-to-moderate adverse effects necessitating no more than local or noninvasive intervention. “The majority of people experienced only mild adverse effects” conveys this more clearly. 2) The treatment may have numerous (even severe) adverse effects, but physicians and patients expected those effects, and patients were able to complete the treatment without dose reduction. “Although XX% experienced severe adverse effects, YY% completed treatment without dose reduction” conveys this. 3) The treatment may have had severe toxic effects that necessitated treatment discontinuation or even caused death. If patients have died from a treatment, that treatment should be called life-threatening (accompanied by an appropriate explanation). These 2 articles highlight how we as investigators and clinicians often fail to communicate clearly with each other and our patients despite our best intentions. More specifically, the authors examine how we convey potential adverse effects of treatments and TSs and then explore how these statements come to have different meanings. The authors of both articles assert, directly or indirectly, that there often is a divergence between the intended meaning and the received meaning, which ultimately affects informed consent and shared decision making. They claim that this divergence stems from differing ideas and asymmetry in clinical knowledge and experience. Furthermore, the authors contend that differing assumptions about the conversation or the data further complicate this dynamic. According to the empirical data presented by Batten and colleagues, physicians assume TSs are made to communicate that something can be done and to clarify what that is.2 In contrast, patients assume that TSs are made to provide news about their future. The authors hypothesize that these differences in reasoning are grounded in differing understandings of the conversational context. For example, physicians tend to approach conversations on serious illness with informed consent in mind. Ultimately, they conclude that such divergences lead to statements that then become either under-informative or falsely informative. Whether or not these pragmatic misfires can be identified and/or overcome via communication strategies is a topic for further research. In the meantime, careful attention to this divergence in meaning can inform and hopefully improve our shared decision-making conversations and teach back. Lack of attention to these features that result in invisible miscommunication risks the loss of relevant information and the conveyance of unintended information, which threaten the very values we seek to uphold. Timothy Mark Corbett, MD MA HMDC FAAHPM, Trellis Supportive Care and Wake Forest School of Medicine, Winston-Salem, NC Batten JN, Wong BO, Hanks WF, Magnus DC. Treatability statements in serious illness: the gap between what is said and what is heard. Camb Q Healthc Ethics. 2019;28(3):394-404. Sacks CA, Miller PW, Longo DL. Talking about toxicity—“what we’ve got here is a failure to communicate.” N Engl J Med. 2019;381(15):1406-1408. 1.Schillinger D, Piette J, Grumbach K, et al. Closing the loop: physician communication with diabetic patients who have low health literacy. Arch Intern Med. 2003;163(1):83-90.2.Batten JN, Kruse KE, Kraft SA, Fishbeyn B, Magnus D. What does the word ‘treatable’ mean? Implications for communication and decision making in critical illness. Crit Care Med. 2019;47(3):369-376. South Asians are one of the largest ethnic minorities in western countries.1,2 What are older South Asian migrants’, relatives’, and healthcare providers’ (HP) perspectives on palliative care (PC)? This review summarized the international evidence on experiences with and perspectives on PC among older South Asian migrants, relatives, and HPs. Empirical studies (qualitative/quantitative/mixed methods) and literature reviews, published 2000-2018, were searched. Ten areas were scored for methodological quality (1 [very poor] to 4 [very good], max=40): title/abstract; introduction/aims; method/data; sampling; data analysis: ethics, bias, results; transferability/generalizability; and implications/usefulness. Thematic synthesis was used. Thirty articles (scores ranging 23-39) were included (qualitative [24], quantitative [5], and mixed methods [1]). Three themes were discovered: 1) PC practice within the family. Home was the preferred place of care/death; family care was the best for retaining patients’ dignity and comfort near death; however, at-home caregiving was physically, mentally, and financially burdensome for relatives. 2) Trust as a precondition of PC. Lack of trust in hospital staff, perceived prejudice/rudeness from HPs, and cultural insensitivity restricted the wish to be cared for in hospitals, and language barriers limited patients from discussing PC. 3) The importance of knowledge and cultural competency. Limited knowledge about PC and available services was complicated by the lack of culturally equivalent words for PC and hospice care, communication was the key factor in PC access, and communication barriers also existed within patients’ families. Studies advocated cultural education/training among HPs to facilitate access to services and to mitigate care inequalities. Hospice and PC providers strive to provide care for all patients with PC needs. Research attempts to determine ways to minimize obstacles and prejudices—a challenging task. This study highlights the importance of cultural competency for South Asians. Because the study subjects come from 8 countries with numerous cultures, languages, and religions, and encompasses works from 3 continents and 5 countries, the findings are not specific to a particular South Asian culture. Improving patient and family satisfaction was attributed to the successful implementation of the 3 emergent themes. In many respects, these themes are the basis of good PC, with an adaptation by clinicians for culturally specific PC. While working to overcome the challenges of delivery and distribution of PC, it is important to identify and provide the basic tenets of PC for individuals in the context of their unique community’s cultures, values, and communication styles. Jane Loitman, MD, Washington University School of Medicine, St. Louis, MO Shabnam J, Timm H, Nielsen DS, Raunkiaer M. Palliative care for older South Asian migrants: a systematic review. Palliat Support Care. 2019:1-13. 1.Morency JD, Malenfant EC, Maclsaac S. Immigration and diversity: population projections for Canada and its regions, 2011 to 2036. Statistics Canada Catalogue no. 91-551-X. http://www.statcan.gc.ca/access_acces/alternative_alternatif.action?l=eng&loc=/pub/91-551-x/91-551-x2017001-eng.pdf. Published January 25 2017.2.South Asian Americans Leading Together. A demographic snapshot of South Asians in the United States. http://saalt.org/wp-content/uploads/2012/09/Demographic-Snapshot-Asian-American-Foundation-2012.pdf. Updated July 2012. Older adults with multiple chronic conditions (MCCs) receive substantial health care.1 Does care for older adults with MCCs that is aligned with their health priorities improve outcomes? This study, at a multisite primary care practice, evaluated whether patient priorities care (PPC) is associated with a perception of more goal-directed and less burdensome care vs. usual care (UC). PPC entails patients identifying their goals and preferences and clinicians aligning their decision making with these priorities. Participants had ≥3 chronic conditions cared for by PPC-trained primary care practitioners (PCPs); similar patients received UC from PPC-untrained PCPs. Enrollment occurred 2017-2018, and follow-up was up to 9 months. The Older Patient Assessment of Chronic Illness Care (O-PACIC) and CollaboRATE measured patients’ perceptions about whether their care was collaborative and focused on their goals, and the Treatment Burden Questionnaire (TBQ) measured perceptions of burdensomeness. Analyses used χ2, t-tests, and linear/logistic regression. Patients (N=366) were 64% female and 96% white. Versus UC, PPC participants were older (mean age 75 [SD=6.6] vs. 78 [SD=7.6] years) and had lower physical/mental health scores. At follow-up, PPC reported a 5-point greater TBQ decrease vs. UC (β=-5 [SE=2.04]; P=.01), using a weighted model with inverse probability of PCP assignment weights; no O-PACIC or CollaboRATE differences were seen. Priorities-based decisions were mentioned in clinical visit notes for 66% of PPC vs. 0% of UC participants. Versus UC, PPC patients were more likely to have medications stopped (weighted comparison, 52% vs. 34%; AOR=2.05; 95% CI=1.43-2.95) and less likely to have self-management tasks (58% vs. 62%; AOR=0.59; 0.41-0.84) and diagnostic tests (81% vs. 86%; AOR=0.22; 0.12-0.40) ordered. Older adults with multimorbidity often are told by their healthcare providers to focus on goals that are potentially burdensome (eg, tight glycemic control) and unlikely to improve outcomes that matter to them (eg, spending more time with family and less time at physicians’ offices). PPC, which is well described at patientprioritiescare.org, is a tool that helps practitioners refocus their clinical interventions on what matters most to patients and, according to this study, improve outcomes. Palliative care practitioners should advocate for more research and implementation of care models such as PPC to improve goal-concordant care among patients with multimorbidity. Implementation of PPC is associated with reduced treatment burden and unwanted health care among older adults with multimorbidity and is a promising tool for improving care for this population. C. Bree Johnston, MD MPH, University of Arizona College of Medicine, Tucson, AZ Tinetti ME, Naik AD, Dindo L, et al. Association of patient priorities–aligned decision-making with patient outcomes and ambulatory health care burden among older adults with multiple chronic conditions: a nonrandomized clinical trial [published online ahead of print October 7, 2019]. JAMA Intern Med. https://doi.org/10.1001/jamainternmed.2019.4235. 1.Chevarley FM. Expenditures by number of treated chronic conditions, race/ethnicity, and age, 2012. Agency for Healthcare Research & Quality. Statistical Brief No. 485.https://meps.ahrq.gov/mepsweb/data_files/publications/st485/stat485.pdf. Published December 2015. Accessed February 21, 2019. Medicare beneficiaries are increasingly admitted to an intensive care unit (ICU) in the last month of life (∼30% in 2015).1 How do ICU end-of-life care resources affect patient outcomes? This retrospective cohort study among Medicare fee-for-service beneficiaries who were admitted to Pennsylvania ICUs (2014-2015) analyzed the association of ICU end-of-life care resources with patient outcomes. Patient-level data were linked with the results of a 2014 survey completed by nurse managers from 61% of Pennsylvania ICUs. The survey included questions about the availability of 5 end-of-life care resources 1 hospital-based resource (palliative care [PC] consultants) and 4 ICU-based resources (protocol for withdrawal of life-sustaining therapy, triggers for automated PC consultation, family meetings protocol, and PC clinicians embedded in ICU rounds). The primary outcome was in-hospital mortality. Chi-square, t-test, and mixed-effects regression analyses were used. Patients (N=63,645; 24% acute renal failure; 78 hospitals) were mean age 74 (SD=12) years, 50% female, and 85% white. After adjustment for illness severity, chronic comorbidities, and hospital characteristics, admission to a hospital with end-of-life resources (86% of patients) was not associated with mortality, length-of-stay, or treatment intensity; however, it was associated with a higher likelihood of discharge to hospice (odds ratio [OR]=1.58; 95% CI=1.11-2.24), an effect driven by ICU-based (OR=1.37; 1.04-1.81) rather than hospital-based (OR=1.19; 0.83-1.71) resources. Instrumental variable analysis demonstrated that among those for whom differential distance (additional travel distance needed to reach a hospital with end-of-life resources) would influence receipt of end-of-life resources, admission to a hospital with such resources was not associated with any outcome. In this creatively designed database study, researchers linked the availability of various end-of-life care resources with Medicare claims data. Despite multiple thorough statistical approaches, no association could be found between the presence of these resources and mortality, intensity of treatment, or length of stay. This should reassure PC skeptics that systems to improve ICU PC do not result in premature withdrawal of life support. The study’s finding of increased hospice discharges is especially notable in this ICU setting where hospice discharges can be difficult to arrange. Unfortunately, this study did not include any assessment of the quality of the end-of-life resources available, nor did it address the dose effect of more than 1 end-of-life resource. The availability of PC consultation embedded PC clinicians on rounds, PC triggers, and end-of-life protocols significantly increases the likelihood that ICU patients will be discharged to hospice with no increase in mortality. Nina O’Connor, MD FAAHPM, University of Pennsylvania, Philadelphia, PA Ashana DC, Umscheid CA, Stephens-Shields AJ, et al. Determining the association between end-of-life care resources and patient outcomes in Pennsylvania ICUs. Crit Care Med. 2019;47(11):1591-1598. 1.Teno JM, Gozalo P, Trivedi AN, et al. Site of death, place of care, and health care transitions among US Medicare beneficiaries, 2000–2015. JAMA. 2018;320(3):264-271. Parents of children with cancer report anxiety, depression, and posttraumatic stress when treatment is over.1,2 How can psychosocial well-being be improved among children with cancer and their parents? This study determined if individual- or group-based delivery of the Promoting Resilience in Stress Management for Parents (PRISM-P) intervention, vs. usual care, improves psychosocial outcomes among parents/guardians of children (2-24 years old) receiving a new malignant neoplasm diagnosis. Parents completed surveys at enrollment (2016-2018) and 3-month follow-up at Seattle Children’s Hospital. PRISM-P targeted 4 skills: stress management, goal setting, cognitive reframing, and meaning-making. For one-on-one delivery, skills were taught privately and in person (30-60 minutes) every other week. For group delivery, skills were taught in a single session with ≥2 parents present. Parents (32 one-on-one, 32 group, and 30 usual care) were median age 35-38 (IQR=31-44) years and predominantly white, college-educated mothers. Their children were median age 5-8 (IQR=3-14) years and 58% male, and the most common cancer was leukemia/lymphoma. One-on-one delivery was associated with improvement vs. usual care for resilience (β=2.3; 95% CI=0.1-4.6; P=.04) and benefit finding (β=0.5; 0.2-0.8; P=.001). This study explored intrafamily relationships in psychosocial well-being among adolescent and young adults (AYAs) with cancer and their mothers. Data were from the “Resilience in Adolescents and Young Adults with Cancer” study, a multisite, prospective, longitudinal cohort study of AYAs with newly diagnosed, non–central nervous system cancer requiring chemotherapy and their parents. Dyads completed patient-reported outcome measures of self-perceived resilience (Connor-Davidson resilience scale) and distress (Kessler-6 psychological distress scale) at baseline (14-60 days postdiagnosis) and follow-up (3-6 months later). AYAs (54% leukemia/lymphoma, 36% sarcoma) were mean age 17 (range=15-22) years, 39% female, and 86% white. Mothers were 47 (33-60) years and 93% white. Fourteen dyads completed follow-up. At each timepoint: ≥1/3 of AYAs and 1/3 of mothers reported high distress, and resilience scores were similar to established general population norms. Higher baseline AYA distress predicted better follow-up maternal resilience (β=0.51; P=0.015). Higher baseline maternal distress predicted worse follow-up AYA resilience (β=-0.48; P=0.043). Parents of children with cancer experience high stress with only few interventions specifically targeting their well-being. Usual care is referral to psychosocial clinicians outside the pediatric hospital setting when distress becomes severe. PRISM is a novel resilience intervention for AYAs with cancer that has shown higher patient-reported resilience, quality of life, hope, and benefit finding and lower distress, thus resulting in parents of AYAs wanting similar intervention for themselves.3,4 Hence, PRISM-P was adapted. To minimize variance, the same psychologist delivered this phase 2 trial. The intervention groups received one-on-one or group sessions along with boosters in person, by email, or by phone. With 22 parents in each mode of intervention compared to the usual care group, one-on-one intervention showed statistically significant improvement in benefit finding and resilience. Though the Lau et al. study was a small sample size, it showed that the distress in either the AYA or the mother could influence their resilience, influence their coping, and eventually affect their quality of life and psychosocial outcomes. This study may need retesting on a larger sample size. Based on these 2 studies, with recognition of distress in AYA or the parent, interventions such as PRISM for AYAs and PRISM-P for their parents can have a positive change in their psychosocial trajectory. PRISM-P is a reproducible intervention to improve parental benefit finding and resilience, which could eventually improve AYA coping as a result of reduced parental (maternal) distress. Sue and Sreedhar, Sue S. Sreedhar, MD, Johns Hopkins All Children's Hospital, St. Petersburg, FL Rosenberg AR, Bradford MC, Junkins CC, et al. Effect of the promoting resilience in stress management intervention for parents of children with cancer (PRISM-P): a randomized clinical trial. JAMA Netw Open. 2019;2(9):e1911578. Lau N, Yi-Frazier JP, Bona K, Baker KS, McCauley E, Rosenberg A. Distress and resilience among adolescents and young adults with cancer and their mothers: an exploratory analysis [published online ahead of print August 28, 2019]. J Psychosoc Oncol. 1-7. https://doi.org/10.1080/07347332.2019.1656317. 1.Rosenberg AR, Dussel V, Kang T, et al. Psychological distress in parents of children with advanced cancer. JAMA Pediatr. 2013;167(6):537-543.2.Kearney JA, Salley CG, Muriel AC. Standards of psychosocial care for parents of children with cancer. Pediatr Blood Cancer. 2015;62(suppl 5):S632-S683.3.Rosenberg AR, Bradford MC, Barton KS, et al. Hope and benefit finding: results from the PRISM randomized controlled trial. Pediatr Blood Cancer. 2019;66(1):e27485.4.Rosenberg AR, Bradford MC, McCauley E, et al. Promoting resilience in adolescents and young adults with cancer: results from the PRISM randomized controlled trial. Cancer. 2018;124(19):3909-3917. Little attention has been given to the role of social support networks among African American people living with HIV/AIDS (PLHIVs).1,2 What affects PLHIVs’ likelihood of naming a decision maker and talking to family/friends/doctors about advance care planning (ACP)? This study identified support network factors associated with naming a decision maker and talking to family/friends/doctors about ACP among African American PLHIVs recruited from a large urban HIV clinic. The research was conducted as a mixed-methods, longitudinal study of PLHIVs (current/former drug users) and their caregivers who participated in 3 semiannual surveys (2014-2016). A support network inventory was used to calculate the number of people available for support: emotional, financial, informational, and physical/transportation assistance. Multivariable logistic regression models examined associations between network factors and discussion, adjusting for sociodemographics and number of members. The Hosmer-Lemeshow test, likelihood-ratio chi-square test, and pseudo R2 assessed fit. Participants (N=370) were 95% African American, 56% male, and 48% less than high school educated. Thirty-nine percent endorsed current cocaine or heroine use, and 62% endorsed current alcohol use. Forty-eight percent had talked to their family/friends/doctor about ACP, and 34% had named a decision maker. In all models, female sex was associated with increased likelihood of talking about ACP with family/friends. Social support network factors associated with talking about ACP included: closeness of network (adjusted odds ratio [aOR]=1.32, 95% CI 1.07-1.62), size of network (aOR 1.11, 95% CI 1.01-1.22), network providing health information (aOR 1.38, 95% CI 1.07-1.80), or physical assistance (aOR 1.25, 95% CI 1.01-1.56). Network factors associated with naming a decision maker included: providing health information (aOR 1.22, 95% CI 1.04-1.43), emotional support (aOR 1.48, 95% CI 1.16-1.88), or reminders of medical care needs (aOR 1.30, 95% CI 1.06-1.60). This study aimed to highlight variables that palliative care teams may consider when initiating ACP for the underserved and understudied population of African American PLHIVs. Findings suggest key elements of social networks are important factors of successful ACP. In particular, clinicians should explore the quality and quantity of a patient’s social network. What remains unclear from this analysis is the role of current substance abuse as an additional consideration. Indeed, half of the patients enrolled on this study endorsed current substance use and that variable was not included in statistical models. Furthermore, while appropriate for an exploratory analysis, the authors did not account for the multiple comparisons they evaluated. This undermines confidence in the findings. African Americans PLHIVs represent an underserved population who would benefit from ACP. This study suggests that ACP will be more successful if clinicians explore and leverage patients’ social networks as part of their standard approach. Kate Aberger, MD FACEP, St. Joseph's Healthcare System, Paterson, NJ Cruz-Oliver DM, Tseng TY, Mitchell MM, et al. Support network factors associated with naming a health care decision-maker and talking about advance care planning among people living with human immunodeficiency virus [published online ahead of print August 22, 2019]. J Pain Symptom Manage. pii: S0885-3924(19)30505-6. https://doi.org/10.1016/j.jpainsymman.2019.08.019. 1.Anderson JD, Li X, Qiao S, Zhou Y, Shen Z. The mediating effects of functions of social support on HIV-related trauma and health-related quality of life for PLHIV in China [published online ahead of print June 7, 2019]. AIDS Care. 1-8.2.Knowlton AR. Informal HIV caregiving in a vulnerable population: toward a network resource framework. Soc Sci Med. 2003;56(6):1307-1320. The concurrent use of opioids with benzodiazepines or nonbenzodiazepine sedatives (S) (vs. opioids alone) has been associated with a higher risk of overdose death.1,2 What is the frequency of concurrent opioid/benzodiazepine-S use, and what are the associated risk factors among patients with cancer? This retrospective study examined the frequency and trend of concurrent opioid/benzodiazepine-S use and associated risk factors among patients with cancer. Electronic health records of 1500 randomly selected adult patients referred to the outpatient palliative care clinic (PCC) at the University of Texas MD Anderson Cancer Center (2011-2016) were reviewed. Demographic and clinical predictors of 418 opioid/benzodiazepine-S patients vs. an equal-but-random sample of 418 opioids-only patients were compared. Analyses used descriptive statistics and univariate/multivariate logistic regression and Cochran-Armitage, Wilcoxon rank-sum, chi-square, and Fisher’s tests. Concurrent opioids/benzodiazepine-S patients were age median=55 (IQR=48-62) years, and opioids-only patients were 56 (49-63). In 2011, upon referral to the PCC, 43% of patients with cancer were prescribed opioids/benzodiazepine-S. This rate declined to 31% by 2016 (P=.0008). The opioid/benzodiazepine-S group had a higher percentage of females (55% [P=.007]) and whites (77% [P=.002]), and patients reported higher median Edmonton System Assessment Scale scores regarding depression (P=.0001), anxiety (P≤.0001), drowsiness (P=.048), and worst feeling of well-being (P=.001). The morphine equivalent daily dose was higher among opioid/benzodi