Supportive Care Research Articles

Multisite Randomized Controlled Trial of CareSTEPS: A Supportive Care Intervention for the Family Caregivers of Patients With Advanced Lung Cancer

ObjectivesPatients with advanced lung cancer (LC) face significant physical, psychological, and functional challenges, increasing their reliance on caregivers. This study evaluates the efficacy of CareSTEPS (Self-Care, Stress management, Symptom management, Effective communication, Problem-solving, and Social support), a 6-week telephone-delivered intervention designed to improve psychological functioning (depression and anxiety symptoms) and reduce caregiver burden among family caregivers of patients with advanced LC. MethodsIn this multisite, open-label, parallel-group randomized controlled trial, 174 caregivers (74.1% female individuals, 40.2% from a racial or ethnic minority group) of patients with stage IIIB or IV NSCLC or extensive-stage SCLC completed baseline surveys and were randomly assigned to CareSTEPS (n = 87) or usual care (n = 87) using stratified block randomization. Caregivers in the CareSTEPS arm received a manual with information on self-care, stress management, symptom management, effective communication, problem-solving, and social support. They also participated in six weekly telephone sessions with Masters-level trained interventionists with a mental health background, who provided psychoeducation, skills training, and support. Eight weeks after baseline, caregivers completed a follow-up survey. ResultsUsing an intent-to-treat framework, analyses of covariance were conducted to assess the efficacy of CareSTEPS, with p values lower than 0.05 indicating significant differences. Caregivers who received CareSTEPS reported improved psychological functioning and lower burden compared with those who received usual care, with effect sizes ranging from small to large (depression d = −0.55, anxiety d = −0.81, burden d = −0.37). ConclusionsThe CareSTEPS intervention reports great promise in meeting the critical support needs of the family caregivers of patients with advanced LC, significantly improving caregivers' psychological functioning and reducing their burden. Overall, the findings emphasize the importance of incorporating caregiver support into the comprehensive management of advanced LC. Clinical Trial RegistrationClinicalTrials.gov NCT02414672.

In focus: Engaging Black and African American women in oncology supportive care interventions.

54 Background: For individuals navigating cancer, unaddressed psychosocial needs can adversely impact quality of life, treatment adherence, and healthcare expenditures. It is recognized that African American cancer survivors are more likely to experience distress, yet they are underrepresented in studies that evaluate interventions. Mind Over Matter (MOM) is a five-week psychoeducational program aimed at bolstering emotional coping skills. A previous study among predominantly White female-identifying breast cancer survivors revealed improvements from pre to post-MOM for anxiety, depression, and physical symptom severity and interference; no data exists for women who identify as Black and/or African American. This presentation will illustrate the strategies and processes implemented to recruit, consent, and retain Black and African American cancer survivors to test the feasibility and acceptability of MOM. Methods: In forming the research team, the diversity in institutions, experience, racial and cultural identities, and professional perspectives were prioritized. As a result of this process, team members were social workers and psychologists, one was at an HBCU institution, and another was a patient advocate from the Black community who was hired and trained enabling full participation in the research process. To improve access all aspects of the study were available online and the intervention was offered virtually in the evening to support participants' availability. Efforts were made to build relationships with non-profit organizations, then disseminating the study through emails, healthcare systems, and social media. Results: During the 3-month recruitment period, 79 individuals expressed interest in the study via email and the study website. Of these, 40 participants (50.6%) enrolled in the study, surpassing the goal of 27. Half of the enrolled survivors learned about the study through community, medical, and academic organizations, while 20% and 10% were referred via the home health system and social media, respectively. 17.5% were referred from unspecified sources. Conclusions: Through robust team development, strategic community partnerships, using a study design that addressed common barriers (e.g., program hours and delivery method, tech orientation, incentives) and a high touch approach, this study successfully enrolled half of the Black and African American female-identified cancer survivors who expressed interest in this mixed-methods study. Clinical trial information: NCT06168825 .

Oncology care model cost data for breast, lung, and multiple myeloma: Influence of outpatient rehabilitation therapy services.

14 Background: High value cancer care is defined by access to coordinated, appropriate healthcare services that achieve optimal outcomes at a reasonable cost. Evidence supports outpatient cancer rehabilitation (physical, occupational or speech therapy) as a mechanism to improve outcomes such as health-related quality of life, suggesting that integration of these services is beneficial for cancer survivors. However, the impact of outpatient rehabilitation services on healthcare costs is unknown. We aimed to compare cost segments between those who attended community-based outpatient rehabilitation therapy services (Rehab) versus those who did not (Non-rehab). We hypothesized that healthcare costs would be lower for the Rehab group in the following cost segments: emergency department (ED), part D drugs, home health services, skilled nursing facility services (SNF), inpatient rehabilitation facilities (IRF), and hospice. Methods: This is a retrospective cohort study of Medicare beneficiaries who received chemotherapy at a large community oncology practice that participated in the oncology care model (OCM) program from 2018 to 2021. Two data sources were linked, OCM cost data and the rehabilitation medical record. This yielded sufficient sample sizes for analysis of breast, lung, or multiple myeloma (MM) cancer types. Rehab cases were then matched to Non-rehab cases 3:1 based on cancer type, stage, and sex. Cost variables included total cost of care (TCOC) and cost segments using OCM methodology. Mann-Whitney-Wilcoxon statistic (p<.05) was used for analysis. Results: Cases (N=3,033) primarily had early-stage cancer (0 to 2, 74.8%) and were 70.4±7.3 (Rehab) or 71.6±8.5 years old at diagnosis (Non-rehab). Most had breast cancer (81.2%), followed by lung cancer (11.7%) and MM (7.2%). TCOC was $32,387 and $26,257 for the Rehab and Non-rehab groups, respectively. Costs were significantly lower for the Rehab group in five of the six segments analyzed; IRF costs were lower, but not statistically significant (Table). Conclusions: To our knowledge, this is the first study to explore the influence of real-world, outpatient cancer rehabilitation therapy services on the cost of cancer care. Community-based therapy services were associated with significantly lower costs in ED, part D drugs, home health, SNF, and hospice segments. Future studies examining rehabilitation services as a relatively low-cost supportive care option to meet patient needs and enhance high-value care are warranted. Healthcare segment costs for rehab vs. non-rehab cases. Rehab Non-rehab Between-group Difference Mean, (SD) Mean (SD) p-value ED $85 (260) $104 (372) .019 Part D drugs $4,813 (18,221) $5,675 (18,797) <.001 Home health $433 (1,600) $705 (2,118) <.001 SNF $160 (1,988) $386 (3,943) .046 Hospice $75 (770) $198 (1,529) <.001 IRF $245 (2,275) $384 (3,277) .434

Quality intervention to facilitate clinician-patient discussions of lung cancer biomarker testing at safety net and non safety net centers.

284 Background: Biomarker testing is critical for optimal therapy selection in non small cell lung cancer, but it takes time and may delay treatment, causing patient anxiety and dissatisfaction. Patients want to understand the necessity and timing of biomarker testing and therapy decisions, but clinicians find these discussions challenging, especially with lower health literacy patients. As a solution, we deployed 4R Oncology model (4R = Right Info/Care/Patient/Time) at 10 centers (4 safety net, 6 non safety net). Under 4R, clinicians discuss with patients a Care Sequence, a predeveloped care checklist with visual timing of care, emphasizing biomarker testing within the overall care plan. It includes social and supportive care to address Social Determinants of Health (SDOH). Methods: Interviews with clinicians to examine whether / how Care Sequence helped discuss the need and timing for biomarker testing with patients, including lower health literacy patients. The cohort of clinicians (N=18) included oncologists, fellows and nurses; 10 worked at safety net centers. Results: All clinicians reported that Care Sequence helped explain timing of biomarker testing and the need to wait for results (Table). The majority reported that it helped discussions with lower literacy patients and to train fellows how to discuss these issues and place related referrals. These benefits and most of the rationale were reported at a similar rate by safety net and non safety net clinicians. Conclusions: The 4R Care Sequence is a promising quality tool that helps clinicians, including fellows, manage patients’ awareness and expectations for timing of biomarker testing and therapy decisions in lung cancer. The benefits in discussions with lower health literacy patients at both safety net and non safety net centers suggest that 4R can address disparities in patients’ understanding of these complex issues and may reduce anxiety while awaiting treatment. Does Care Sequence help / rationale % of all clinicians N=18 % of safety net clinicians n=10 % of non safety net clinicians n=8 P value Helps Explain Timing of Biomarkers & Decision, Need to Wait for Results 100 100 100 1 - Describes how biomarker testing fits into overall care plan 94 100 88 .4 - Visually depicts timing of testing & treatment decision 83 80 88 1 - Recommends patients to be active preparing for treatment while waiting 78 80 75 1 - As a standard, normalizes timing of results, decisions 56 30 88 .02* Helps Discuss With Lower Health Literacy Patients 89 90 88 1 - Combines visual timeline & succinct checklist 61 60 63 1 - Uses plain language as possible 39 60 13 .02* - Helps address SDOH while waiting 72 70 75 1 Helps Train Fellows 92 100 67 .2 - Reminds to order biomarkers, other workup 77 80 67 1 - Helps develop narrative, organize discussion of biomarkers 77 80 67 1 - Prompts to discuss SDOH, refer to related care 62 80 0 .04* *Statistically significant, p<.05.

LDH and NLR, as inflammatory markers, the independent risk factors for COVID-19 complicated with respiratory failure in elderly patients.

Lactate dehydrogenase (LDH) is an enzyme that is responsible for the production of lactic acid, which is a necessary byproduct when the body does not have enough oxygen. LDH levels in the blood can be used as a marker to predict mortality in patients with ARDS, severe COVID-19, and cancer. To analyze the clinical characteristics of COVID-19 in the elderly and the correlation between LDH and respiratory failure in COVID-19 patients, to improve the identification and management of this type of pneumonia by clinicians. This was a single-center retrospective study. We performed routine laboratory tests in 105 COVID-19 patients admitted to the affiliated hospital of Qingdao University (Qingdao, China) from October 1, 2022 to February 1, 2023. The diagnosis of respiratory failure was established based on the results of blood gas analysis upon admission. The median age was 79 years. Among all univariable parameters, LDH, neutrophil to lymphocyte ratio (NLR) and Prothrombin Time (PT) were significantly independent risk factors of RF in elderly COVID-19 patients. LDH (AUC=0.829) also had a maximum specificity (96.5%), with the cutoff value of 280.5. The levels of LDH, NLR, and PT may serve as potential indicators for elderly COVID-19 patients combined with respiratory failure. LDH, NLR and PT assays can be beneficial for patients who need closer respiratory monitoring and more aggressive supportive care to prevent a negative prognosis.

Longitudinal assessment of cancer-related distress during cancer treatment using an electronic health record–based tool and impact of social work intervention.

207 Background: Cancer-related distress affects 35-45% of patients. 2020 ASCO-QOPI standards require baseline and ongoing psychosocial assessments, with interventions as needed. We examined the feasibility and outcomes of integrating the NCCN Distress Thermometer (DT) into the oncology electronic health record (EHR) for distress monitoring. Methods: A flowsheet containing NCCN DT questions was created in Epic EHR (Epic Systems, Verona, WI). Oncology nursing staff administered the electronic DT as part of normal patient ‘rooming’ protocol and alerted providers when distress level was ≥ 4 (DT4). This in turn generated a social work (SW) referral. SW interventions were documented in a SW dashboard. Results: Between May 1 st 2023, and April 30 th 2024, our Epic EHR DT was used to screen 6,270 distinct oncology patients, 1,852 scored >=4. 19.7%, 14.2%, 20.4% and 5.4% of the responses were in the emotional, practical, physical, and familial domains respectively. 447 (24.1%) of these patients were referred to SW. When contacted by SW, worry/anxiety in 37.5%, finance in 34.9% and transportation in 29.4% were the top three concerns. Access to grants, free-care, lodging and gas cards was made available to 37.4%, 14.5%, 20.5% and 13.1% of patients respectively. Additionally, in accordance with QOPI certification requirements, 947 patients with active oncology treatment plans were serially screened during successive cycles of chemotherapy generating 6,330 responses. 398 (42%) of these responses indicated DT4. SW referral was placed in 163 (41%) of patients with DT4. Serial distress monitoring revealed a trend towards improved distress in later cycles of chemotherapy, with DT4 percentage decreasing from 27.7% in cycle 1 to 7.9% in cycle 6. Process improvement efforts informed by this data increased DT use from 42.7% to 50% between May-October 2023 and November 2023-April 2024. Conclusions: Electronic capture of cancer related distress as part of routine care is feasible in a community-based oncology program and resulted in a variety of meaningful SW interventions. Cumulatively, distress caused by emotional, social, and practical problems are more frequent than distress caused by physical problems, underscoring the need for comprehensive cancer care. Distress tends to diminish during successive cycles of chemotherapy, possibly due to lower cancer related morbidity due to therapy, or increased patient familiarity with chemotherapy and improved use of supportive care.

EL6 Supportive care in cancer and adverse event management

EL6 Supportive care in cancer and adverse event management

Using patient-reported performance status to guide management of advanced cancer: A quality improvement initiative.

379 Background: Performance status is a key prognostic factor among patients with advanced cancer and can inform the need for supportive care services. However, assessment and documentation of performance status is inconsistently integrated into standard oncology care. Patient-reported performance status (PRPS) is a surrogate for clinician-assessed performance status and has the potential to address this challenge. We piloted a decision support tool in our electronic health record (EHR) that uses PRPS to prompt clinician assessment of performance status and suggest referrals to supportive care services. Methods: We identified patients with advanced cancer using a pre-built and validated registry driven by ICD codes in our EHR (EPIC). For patients with advanced cancer seen at one of our clinics, a multiple-choice question with options derived from the Eastern Cooperative Oncology Group (ECOG) scale in patient-friendly language was added to the pre-visit questionnaire sent electronically prior to oncology visits. For patients with a poor PRPS (2 or greater), a clinical decision support tool alerted providers of the patient’s self-reported performance status, encouraged input of the clinician’s ECOG assessment, and suggested referral orders to supportive care services such as palliative care, nutrition, and social work. We are currently evaluating how our PRPS-driven decision support tool impacts the rate of clinician-assessed ECOG documentation, referral rates, and clinical outcomes. Results: Between 3/13/24 and 5/13/24, of 336 patients identified by the advanced cancer registry, 70% (235) of patients completed the PRPS questionnaire. Among patients with an available PRPS score, 18% (42) of patients reported a poor performance status (2 or greater) at least once, triggering the decision support tool. Providers entered ECOG assessments for 93% (39) of patients and sent referrals to supportive care services for 10% (4) of the patients. Three patients died during this time period, and all three of them reported a poor performance status of 3 or 4. Oncologists at the clinic reported no significant disruption to routine workflow. Conclusions: Preliminary results suggest feasibility of a PRPS-driven decision support tool to flag patients with advanced cancer and declining function and improve discrete documentation of clinician-assessed performance status. Notably, the rate of referrals to supportive care services remains low. Next steps include obtaining longitudinal data from this pilot, assessing the impact of the pilot on goals of care documentation, and validating the concordance of PRPS and ECOG and their effect on clinical outcomes. Ultimately, we aim to use the resulting data and harness our dashboard of patients with advanced cancer and poor performance status to develop innovative, automated, and targeted quality improvement interventions.

Feasibility of Fall-Risk Detection in Older Adults: Real-World Use of Sensor Data With Machine Learning.

To use machine learning techniques with sensor data to predict fall risk in older adults aging in place. We tested the feasibility of using anomaly detection on a dataset comprising 315 days of continuous unobtrusive sensor data obtained from a single participant to predict fall risk within a 10-day window. Predictions were validated with performance metrics, including accuracy, F1 score, and receiver operating characteristic-area under curve (ROC-AUC), using actual falls documented in the electronic health record. The model resulted with accuracy = 0.96 (95% confidence interval [CI] [0.94, 0.99]), F1 = 0.78 (95% CI [0.73, 0.83]), and ROC-AUC = 0.89 (95% CI [0.85, 0.93]). The application of anomaly detection on sensor data may provide a timely and valid indication of fall risk in older adults within a 10-day window. Further research and validation are warranted to confirm these findings and expand the scope of application in the domain of older adult care and health care support. [Journal of Gerontological Nursing, 50(10), 7-10.].

A Study of Intergenerational Support and the Health Relationship of the Elderly Population: Evidence from CHARLS

BackgroundCurrently, the relationship of intergenerational support on health is mainly focused on physical health and mental health, and there are fewer studies on the relationship of intergenerational support on self-assessed health. Therefore, this paper discusses and analyzes the possible relationship of intergenerational support on the self-assessed health of older adults in terms of the bidirectional support of various forms of support between older parents and their adult children in terms of financial, living, and emotional support(CHARLS). MethodsThis study was conducted on participants aged 65 and over, using the CHARLS 2020 survey, involving 6359 (3069 men and 3290 women) elderly people.Health was measured in three dimensions: physical, psychological, and self-assessment; intergenerational support was measured in three dimensions: financial, life care, and spiritual comfort; and regression models analyzed the relationship between intergenerational support and the health of the elderly population. ResultsChildren's life care support ( p<0.05) had a significant positive association on physiological health, but a significant negative association on the elderly's psychological and self-assessed health, children's spiritual comfort support (p<0.05) had a positive association on the elderly's physiological health, psychological health, and self-assessed health, and children's financial support (p<0.05) was positively correlated with the elderly's psychological, and children's financial support had a positive association, but not related to physical health and self-rated health of the elderly. ConclusionsThe relationship between intergenerational support and the health of the older population is complex, with life-care support significantly contributing to physical health but negatively affecting mental health and self-assessed health; spiritual comfort support positively affecting physical, mental and self-assessed health; and financial support having a primarily positive effect on mental health. Therefore, children should fully respect and utilise the ‘autonomy’ of the elderly when providing intergenerational support to the elderly in their families. It is also important to improve intergenerational communication abilities and skills, which will help to better understand and fulfil the needs of older people, thereby promoting their physical and mental health.

Counting the days: Exploring healthcare contact days during episodes of cancer care.

233 Background: Cancer diagnosis and treatment brings about not only emotional upheavals but also logistical hurdles of navigating a fragmented healthcare system. Little is known about the frequency of healthcare contact for cancer patients and its implications. Healthcare contact days, defined as the number of days a patient spends in direct contact with healthcare professionals outside of home, measures the patient’s interaction with the healthcare system. Methods: Using historical claims data (Part A institutional and Part B ambulatory claims) from the Enhancing Oncology Model (EOM) for 12 practices in The US Oncology Network covering the period between January 2019 to June 2022, we derived healthcare contact days per episode (6-month care periods initiating with the administration of chemotherapy), counting each unique date once. When patients encountered multiple care settings on a single date, the following hierarchy was used: inpatient (IP) &gt; emergency room (ER) &gt; skilled nursing facility (SNF)&gt; hospice &gt; ambulatory care. We further counted contact days for different services conducted during the ambulatory visits. Results: For the 75,246 episodes, an average of 31.9 days per episode (1 in every 6 days) were spent in healthcare contact. Cancer patients’ healthcare contact was predominantly within ambulatory care, and visits with oncology providers exceeded that with all other specialties. ER and IP visits, generally a representation of acute care events, accounted for &lt;10% of the contact days. Conclusions: During cancer treatment, patients spend approximately one-sixth of their time in healthcare contact. The optimal frequency of contact, pattern of primary care support, care of comorbidities, and the interrelationship between acute care and clinician visits are apt for further exploration. Healthcare contact days can reflect different care delivery approaches between providers and may be a metric to assess both healthcare efficiency and accessibility. Understanding caregiver burden and social disparities associated with high contact days offers an opportunity to improve care coordination and streamline healthcare encounters while balancing patients’ care needs. CMMI Disclaimer: The statements contained in this document are solely those of the authors and do not necessarily reflect the views or policies of CMS. The authors assume responsibility for the accuracy and completeness of the information contained in this document. Healthcare contact days. Mean Percentiles 5 th -95 th Per Episode Healthcare Contact Days 31.9 10-65 Ambulatory Visits* 8-55 Chemotherapy 6.6 0-18 Imaging 2.7 0-7 Procedure 1.8 0-7 Radiation 2.4 0-23 Testing 11.8 3-25 Clinician Oncology 6 1-14 Other Specialties 3.4 0-10 Primary Care 2.8 0-8 Facility Visits ER 0.4 0-2 Hospice (Facility) 0.1 0-0 IP 2.7 0-16 SNF 0.8 0-0 *Ambulatory visits days are not mutually exclusive.

Examining psychosocial vulnerability in caregivers of individuals with a chronic haematological malignancy. A cross sectional survey.

ObjectiveTo investigate psychosocial vulnerability in informal caregivers of chronic haematological cancer patients and determine the level of psychosocial vulnerability among carers of people living with a CHM. MethodsAn international cross – sectional study including caregivers of individuals with a chronic haematological cancer (n=64) from Ireland (n=29), Australia (n=21), the UK (n=4), the USA (n=4), and India (n=6). Caregivers completed scales for loneliness, resilience, stress and caregiver strain using the UCLA scale, BRS scale, PSS scale and MCSI scale. Descriptive statistics and non-parametric techniques were used. ResultsThe results show that younger carers (aged between 18-40) report higher levels of loneliness, stress and caregiver strain. Carers who have left their paid employment due to caregiving and are in receipt of carers’ allowance or social welfare report high levels of loneliness and caregiver strain. Lower stress levels were reported in those who received paid professional caring support. Finally, higher levels of loneliness in carers were associated with the patient currently being on some form of treatment and higher levels of caregiver strain were associated with caring for someone for more than 8 hours per day and having all social, mental, and financial areas of life affected ConclusionCaregivers of patients with chronic haematological cancers experience psychosocial vulnerability, which is associated with their age, socioeconomic status, gender and health and wellbeing.

Racial disparities in end-of-life care among patients with neuroendocrine tumors.

60 Background: Due to the rising incidence of neuroendocrine tumors (NETs), the prevalence of NETs now surpasses many other malignancies. Due to a slower course of disease and lack of awareness among care teams, end-of-life (EOL) care is typically underutilized in patients with NETs. Owing to a heavy symptom burden (related to disease burden and/or functionality), patients with NETs often struggle due to lack of palliative care and eventually EOL care support. Prior studies have revealed that Black patients with advanced cancer are more likely to receive aggressive care and suffer a significant decline in quality of life at EOL. However, similar data investigating racial differences in EOL among patients with NETs are lacking. Methods: The National Inpatient Sample (NIS) was queried between years 2016-2020 to identify all hospitalizations (regardless of site of origin) with NETs utilizing the appropriate ICD-10 codes (neuroendocrine carcinomas were excluded). Hospitalizations of White and Black patients with documented inpatient mortality events were then extracted. Demographic and clinical data were analyzed using independent sample t-test, Chi-square test, and binary logistic regression (adjusted for age, gender, and Charlson comorbidity index or CCI). NIS discharge weights were applied to calculate national estimates. Statistical analyses were performed with SPSS 28.0. A p-value of &lt;0.05 was considered statistically significant. Results: A total of 6,265 hospitalizations with NETs were included, of which 5,125 (81.8%) and 1,140 (18.2%) had White and Black patients respectively. Black patients were younger, more likely to be females, and less likely to have a do not resuscitate (DNR) code status. There was no significant difference in CCI between the groups. Palliative care consultation was less likely to be performed among Black patients (adjusted OR=0.70, p&lt;.001). Black patients also had longer mean length of stay in the hospital (10.25 vs 8.42 days, p&lt;.001). Black patients were also more likely to receive aggressive care in the form of mechanical ventilation at EOL (Table). Conclusions: This is the largest analysis demonstrating significant racial disparities in EOL care among patients with NETs. Black patients had longer inpatient stay, were less likely to receive inpatient palliative care consultation, have a DNR order and more likely to receive aggressive care at EOL. These findings may have implications for informing healthcare decision making for EOL care among Black patients with NETs. WhiteN=5125 BlackN=1140 aOR (95% CI) p-value Age (years) 67.67 ± 11.89 65.14 ± 11.29 - &lt;.001 Females 46.1% 50.9% - .004 CCI 11.0 ± 3.22 10.9 ± 3.42 - .538 Mean length of stay 8.42 ± 10.03 10.25 ± 15.75 - &lt;.001 Palliative 62.6% 54.5% 0.70 (.61-.80) &lt;.001 DNR 64.9% 60.1% 0.80 (.70-.92) .002 Blood transfusion 13.2% 15.4% 1.18 (.98-1.41) .052 Mechanical ventilation 28.8% 38.6% 1.55 (1.35-1.77) &lt;.001 Vasopressor 9% 9.6% 1.07 (.86-1.33) .47

Palliative care knowledge and access among people with small cell lung cancer and their family caregivers: Preliminary findings.

197 Background: People with small cell lung cancer (SCLC) make up 13-15% of those diagnosed with lung cancer. Although current statistics show the 5-year survival rate of people with lung cancer has improved overall, this is not the case for those diagnosed with SCLC. The disease is rapidly growing and aggressive, making access to palliative care crucial for improving quality of life for both people with SCLC and their family members. We developed a survey to assess palliative care knowledge and access among people with small cell lung cancer and their family caregivers. Methods: An online cross-sectional survey was conducted by the Lung Cancer Registry from GO2 for Lung Cancer (lungcancerregistry.org) from June 2023-present and included questions regarding treatment decision making, palliative care, and access to care. The SCLC survey is promoted to current Lung Cancer Registry participants who indicated a diagnosis of SCLC or were a family caregiver of someone with SCLC. Both people with SCLC and their family caregivers are eligible to participate in the survey. We also recruited people with SCLC through additional targeted online recruitment, direct outreach to community hospitals, and healthcare providers. Descriptive statistics were used to summarize survey findings. Results: As of May 2024, the SCLC survey was completed by 20 participants (mean age, 62 years; White, 85.0%; female, 55.0%; diagnosed with SCLC, 95.0%). Over half of people with SCLC (n = 11, 55.0%) had a family caregiver. While most participants had heard of palliative care (n = 15, 75.0%), less than half (n = 9, 45.0%) were offered or given information about it. Half of participants (n = 10, 50.0%) received or indicated they would like to receive palliative care. When asked what was needed from palliative care amongst these individuals, medication management for pain and physical symptoms was the top response (26.9%). For those who did not receive or would not like to receive palliative care, the top reasons included that it was not offered to them (26.7%) and wanting to learn more about it first to guide their decision-making (20.0%). Lastly, when asked what type of palliative care support was needed, emotional support was the top response (27.3%) followed by information on coping with lung cancer (24.2%). Conclusions: Preliminary findings suggest efforts are needed by care teams to expand access and improve education regarding palliative care among people with SCLC and their family caregivers. The fast-growing, aggressive nature of SCLC makes it especially urgent that care teams reach and meet the needs of this population. Our findings thus far highlight the need for additional research with larger sample sizes to ensure generalizability for the small cell lung cancer community.

Antibody-Drug Conjugates and Their Potential in the Treatment of Patients with Biliary Tract Cancer.

Background: Biliary tract cancers (BTCs) are aggressive in nature, often presenting asymptomatically until they are diagnosed at an advanced stage. Surgical resection or liver transplantation are potential curative options. However, a large proportion of patients present with incurable locally advanced or metastatic disease and most of these patients are only eligible for palliative chemotherapy or best supportive care. More recently, targeted therapies have proven beneficial in a molecularly selected subgroup of patients with cholangiocarcinoma who have progressed on previous lines of systemic treatment. However, only a minority of patients with BTCs whose tumours harbour specific molecular alterations can access these therapies. Methods: In relation to ADCs, studies regarding use of antibody-drug conjugates in cancer, particularly in BTCs, were searched in Embase (1974 to 2024) and Ovid MEDLINE(R) (1946 to 2024) to obtain relevant articles. Examples of current clinical trials utilising ADC treatment in BTCs were extracted from the ClinicalTrials.gov trial registry. Conclusions: Overall, this review has highlighted that ADCs have shown encouraging outcomes in cancer therapy, and this should lead to further research including in BTCs, where treatment options are often limited. The promising results observed with ADCs in various cancers underscore their potential as a transformative approach in oncology, warranting continued exploration and development and the need for education on the management of their specific toxicities. By addressing current challenges and optimising ADC design and application, future studies could potentially improve treatment outcomes for patients with BTCs and beyond, potentially in both early and advanced stage settings.

Report from the Third Conference in Zielona Góra: palliative medicine, supportive care, and pain management

Report from the Third Conference in Zielona Góra: palliative medicine, supportive care, and pain management

Cartap Poisoning with Paroxysmal Supraventricular Tachycardia: A Case Report

Cartap, a nereistoxin derivative from the marine annelid Lumbriconeresis heteropoda, is widely used as a pesticide, targeting pests like caterpillars. While the WHO classifies it as moderately hazardous, with a recommended daily intake of 0.05 mg/kg, human toxicity reports are limited. A 34-year-old female was admitted after consuming an unknown poison. She reported epigastric pain, burning sensations, sweating, vomiting, dyspnea, palpitations, and restlessness, compounded by alcohol intake. Initially treated for organophosphate poisoning, her cholinesterase level was 8.91. It was later confirmed she ingested 100 ml of 50% concentration cartap. Treatment included amiodarone for supraventricular tachycardia and intravenous N-acetylcysteine, magnesium sulfate, and midazolam for general tonic clonic seizure. Cartap, toxic through ingestion and skin contact, can cause symptoms such as vomiting, convulsions, and cardiac issues like supraventricular tachycardia. Supportive care is crucial, and awareness of its risks is necessary.

The Role of Exercise in Lymphedema Management: A Bibliometric Analysis

Lymphedema is a lifelong chronic health issue, and exercise approaches are considered one of the gold standards in lymphedema treatment. Numerous articles have been published on exercise approaches in lymphedema. In this study, we aimed to conduct a bibliometric analysis of studies related to exercise in lymphedema. For this purpose, a search was conducted in the Scopus database on October 24, 2023, using the keywords “lymphedema and exercise’’ and 869 documents were examined. Data were downloaded from the relevant search engine. These data were analyzed using the Vosviewer and Biblioshiny package programs. Publication dates ranged from 1957 to 2023. According to the analysis results, while the United States is the leading contributor in terms of article publications (n=979), Austria leads in terms of international collaboration (n=401). The most cited publication using the keywords lymphedema and exercise is the article by Campbell et al. (2019) titled “Exercise Guidelines for Cancer Survivors: Consensus Statement from International Multidisciplinary Roundtable,’’ published in the “Medicine and Science in Sports and Exercise’’ journal with 1101 citations. “Lymphatic Research and Biology”, “Lymphology”, and “Supportive Care in Cancer” are the top three journals with the most citations in this field. Particularly, the University of Pennsylvania stands out as the most prolific institution contributing to this area with productive research output. The most prolific author with 29 articles is Kathryn H. Schmitz. The most frequently used keywords include “lymphedema”, “breast cancer”, and “lymphedema, quality of life”. The findings of this study are valuable not only for researchers and practitioners interested in lymphedema and exercise but also for anyone interested in practical applications and potential future developments. Ultimately, this comprehensive information guide could serve as an important resource and roadmap for future studies.

Right Lung Agenesis Associated with Dextrocardia in Adulthood

Introduction: Pulmonary agenesis is a rare lung disease, occurring in approximately 1 out of every 100,000 births. Most cases of pulmonary agenesis result in death during the neonatal period. Although survival in cases of pulmonary agenesis is rare, it is possible to encounter lung agenesis in adults. Case: A 26-year-old female patient presented with progressive dyspnea. On physical examination, retraction of the breathing muscles, reduced chest excursions, and decreased breath sounds on the right side were observed. A chest X-ray raised suspicion of pulmonary agenesis. A computed tomography (CT) scan showed hypoplasia of the right lung, accompanied by mediastinal shift, hyperinflation of the left lung, and retraction of the diaphragm and liver to the right. Spirometry showed moderate obstruction. Conclusion: Pulmonary agenesis in adult patients is extremely rare. Chest X-rays and CT scans are the main diagnostic modalities for pulmonary agenesis. There is no specific treatment for asymptomatic cases. Management focuses on conservative and symptomatic care.

Integration of supportive, palliative, and hospice care with other medical and non-medical specialties

Integration of supportive, palliative, and hospice care with other medical and non-medical specialties