Clinical and demographic variables of young adult (YA) patients referred to inpatient supportive care.

2018 ◽  
Vol 36 (34_suppl) ◽  
pp. 168-168
Author(s):  
Sujin Ann-Yi ◽  
Angelique Wong ◽  
Jimin Wu ◽  
Maira Charone ◽  
Karen Baumgartner ◽  
...  
Keyword(s):  
Young Children ◽  
Supportive Care ◽  
Cancer Patients ◽  
Financial Distress ◽  
Eastern Cooperative Oncology Group ◽  
Age Groups ◽  
Social Needs ◽  
Aged Patients ◽  
Age Cohorts ◽  
Pain Expression

168 Background: Literature suggests that YA cancer patients have unique psychosocial issues and more emotional distress compared to older aged patients. Our study aimed to evaluate clinical and demographic factors of YA cancer patients that may impact physical and psychosocial symptom expression. Methods: A retrospective review was conducted on randomly selected patients seen during 2013-2015 of 3 age groups: 18-39 (YA), 40-64, and 65 and older on demographic, medical, psychosocial history, Morphine Equivalent Daily Dose (MEDD), Edmonton Symptom Assessment Scare (ESAS) scores, and Eastern Cooperative Oncology Group (ECOG) scores which are completed at time of initial consultation with the supportive care inpatient mobile team. Results: 896 (YA = 297, 40-64 cohort = 300, 65 and older = 299) patients were reviewed. YA cohort was associated with being female (n = 179 (60%), p = 0.03), more frequently non-white (Black and Hispanic = 124 (42%), p < 0.00), higher ECOG scores (ECOG 0-2 = 83(39%), p < 0.00) more psychiatric history (n = 95(32%), p = 0.00) and worse ESAS sleep scores (median = 6, p = 0.02). The YA cohort also had higher pain expression than the 65 and older cohort (p = .02). The YA group was more likely to have children younger than 18 years old (n = 171(58%), p < 0.00). Patients with children less than 18 years of age reported higher pain expression (median = 6, p = .05), sleep (median = 6, p = 0.01), and financial distress (median = 2, p = 0.02). Conclusions: Contrary to other findings, YA cancer patients did not report higher symptoms or distress when compared to older age cohorts, with the exception of higher insomnia compared to other age cohorts and higher pain expression than the oldest age cohort. YA with young children reported higher level of pain, sleep and financial distress. Our findings suggest that the YA population may benefit from specialized psychosocial services to address their unique social needs, particularly to address concerns related to being parents of young children.

Frequency and factors predicting the risk for aberrant opioid use in patients receiving outpatient palliative care at a comprehensive cancer center.

2017 ◽  
Vol 35 (31_suppl) ◽  
pp. 228-228
Author(s):  
Sriram Yennu ◽  
Tonya Edwards ◽  
Joseph Anthony Arthur ◽  
Zhanni Lu ◽  
John M Najera ◽  
...  
Keyword(s):  
At Risk ◽  
Multivariate Analysis ◽  
Drug Use ◽  
Supportive Care ◽  
Cancer Patients ◽  
Financial Distress ◽  
Male Gender ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Edmonton Symptom Assessment Scale

228 Background: Opioid misuse is a growing crisis among patients with chronic pain. Cancer patients at risk of aberrant drug behaviors (ADB) are frequently underdiagnosed in routine cancer care. The aim of this study was to determine the frequency and factors predicting risk for Aberrant Opioid and Drug use among Patients receiving Outpatient Supportive Care Consultation at a Comprehensive Cancer Center Methods: In this retrospective study, 690 consecutive patients referred to a supportive care clinic were reviewed. Patients were eligible if they were ≥18 years, had a diagnosis of cancer, and were on opioids for pain for atleast a week. All patients were assessed with the Edmonton Symptom Assessment Scale (ESAS), SOAPP-14, and CAGE-AID. At risk patients with aberrant opioid behavior (+Risk) was defined as SOAPP-14 score ≥7. Descriptive statistics, spearman correlation coefficient, multivariate analysis were performed. Results: 690/752 consults were eligible. A total of 135(20%)were +risk. 69(11%) were CAGE-AID +.SOAPP-14 scores were positively associated with CAGE-AID p < 0.001; male gender p = 0.007; ESAS pain p = < 0.006; ESAS depression p < 0.001; ESAS anxiety, p < 0.001, and ESAS financial distress p = < 0.001. Multivariate analysis indicated that the odds ratio for +Risk was 2.47 in patients with CAGE-AID+ (p < 0.001), 1.95 for male gender (p = 0.005), 1.11 per point for ESAS anxiety (p = 0.019), and 1.1 per point. for ESAS financial distress (p = 0.02). Conclusions: 20% of cancer patients on opioids presenting to supportive care center are at risk of aberrant drug behavior. Male patients with anxiety, financial distress, and prior alcoholism/illicit drug use are significant predictors of +Risk. Further research to effectively manage these patients is needed.

Frequency and factors predictive of aberrant drug behavior in patients presenting to outpatient supportive care center at a comprehensive cancer center.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 10118-10118
Author(s):  
Sriram Yennu ◽  
Tonya Edwards ◽  
Joseph Anthony Arthur ◽  
Janet L. Williams ◽  
Zhanni Lu ◽  
...  
Keyword(s):  
At Risk ◽  
Supportive Care ◽  
Cancer Patients ◽  
Predictive Value ◽  
Financial Distress ◽  
Care Center ◽  
Male Gender ◽  
Comprehensive Cancer Center ◽  
Edmonton Symptom Assessment Scale ◽  
Outpatient Supportive Care

10118 Background: Opioid misuse is a growing crisis in cancer patients. Cancer patients at risk of aberrant drug behaviors (ADB) are frequently underdiagnosed in routine cancer care. The aim of this study was to determine the frequency and factors associated with ADB using the “Screener and Opioid Assessment for Patients tool” (SOAPP-14) in cancer patients seen at the outpatient supportive care center. We also examined the screening performance of Cut Down, Annoyed, Guilty, and Eye Opener (CAGE-AID) as compared to The SOAPP-14 as a gold standard. Methods: In this retrospective study, 1108 consecutive patients referred to supportive care clinic were reviewed. Patients were eligible if they were ≥18 yrs, have a diagnosis of cancer, and were on opioids for pain for atleast a week. Patients’ demographics, the Edmonton Symptom Assessment Scale (ESAS), SOAPP-14, and CAGE-AID scores were analyzed. ADB+ was defined as SOAPP-14 score ≥7. Descriptive statistics, spearman correlation coefficient, multivariate, and ROC analysis were performed. Results: 703/1108 consults were eligible. A total of 153/703 (22%) were ADB +ve. SOAPP-14 scores were positively correlated with CAGE-AID r = .38, p < 0.001; male gender r = 0.11, p = 0.003; ESAS pain r = 0.11, p = 0.005; ESAS depression r = 0.22, p < 0.001; ESAS anxiety r = 0.22, p < 0.001, and ESAS financial distress r = 0.23, p < 0.001. Multivariate analysis indicated that the odds ratio for ADB +ve was 6.18 in patients with CAGE-AID+ (p < 0.001), 1.8 for male gender (p = 0.007), 1.1/pt. for ESAS anxiety (p = 0.044), and 1.1/pt. for ESAS financial distress (p = 0.007). A CAGE-AID score of 1/4 has a sensitivity of 47%, specificity of 89% positive predictive value 63.6% and negative predictive value 69.2%. Conclusions: Our study suggests that 22% of cancer patients on opioids presenting to supportive care center are at risk of aberrant drug behavior (ADB). Male patients with anxiety, financial distress, and prior alcoholism/illicit drug use are significant predictors of ADB’s. A cut off score of ≥1 out 4 on CAGE-AID questionnaire allows better screening of ADB in outpatient advanced cancer patients. Further research to effectively manage these patients is needed.

Comparing cancer survivors' perceptions on lifestyle behaviors between adolescent-young adult (AYA) and middle-aged patients (pts).

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 207-207
Author(s):  
Spencer Soberano ◽  
Lawson Eng ◽  
RuiQi Chen ◽  
Ashraf Altesha ◽  
Subiksha Nagaratnam ◽  
...  
Keyword(s):  
Physical Activity ◽  
Alcohol Consumption ◽  
Cancer Survivorship ◽  
Age Groups ◽  
Well Being ◽  
Smoking History ◽  
Middle Aged ◽  
Aged Patients ◽  
Age Cohorts ◽  
Lifestyle Behaviours

207 Background: Lifestyle behaviours such as smoking, physical activity, and alcohol consumption are important determinants of cancer survivorship. Previous studies have compared the lifestyle behaviours of elderly and middle-aged patients (pts), yet no studies have compared these behavioural perceptions between AYA (aged 18-39 years) to those of middle-aged pts (MA, 40-64 years). Methods: Cancer pts across various tumour types at a comprehensive cancer centre were surveyed with respect to their perceptions of how their well-being was affected by smoking, physical activity and alcohol consumption after diagnosis. Univariate logistic regression models evaluated factors associated with perceptions on the effect of various adverse lifestyle behaviours on health and well-being. Results: Of 200 AYA (57% female, 43% male) and 772 MA (56% female, 44% male) pts, a positive smoking history was reported by 33% of AYA and 48% of MA (P<0.001). At time of diagnosis, 55% of AYA and 59% of MA pts consumed alcohol, 16% of AYA and 16% of MA were ex-drinkers, and 28% of AYA and 25% of MA were never drinkers (P=0.62). Among AYA, 26% exercised compared to 20% in the MA group (P=0.19). The majority (72-92%) of pts perceived that smoking and lack of activity after cancer diagnosis negatively affected quality of life, survival chances, and fatigue; there were no significant differences between age groups. In contrast, both age cohorts displayed misperceptions about how alcohol affects health, which was characterized by perceiving neutral or beneficial influence on their overall well-being: Fifty-seven percent of MA pts had a borderline greater misperception versus 49% of AYA pts (P=0.06). Misperceptions regarding how alcohol affects survival were observed in 49% of AYA pts and 58% of MA pts (P=0.05). Misperception with respect to how alcohol affects fatigue was observed in 40% of AYA pts compared to 52% of MA pts (P=0.005). Furthermore, MA pts had 1.63 (95% CI 1.16–2.29) times the odds to have misperceptions regarding how alcohol affects fatigue, and 1.41 (95% CI 1.01–1.97) times the odds to have misperceptions on how alcohol affects survival compared to AYA pts. Conclusions: Both the AYA and MA population were not adequately informed about how alcohol affects cancer survivorship health; with more misperceptions in MA pts. Results from this study advocate for survivorship programs to implement emphasis on the deleterious effects of alcohol, with particular efforts tailored to the MA group.

The development of a nomogram to determine the risk for inappropriate opioid use in cancer patients.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 11602-11602
Author(s):  
Sriram J. Yennu ◽  
Rony Dev ◽  
Tonya Edwards ◽  
Joseph Anthony Arthur ◽  
Zhanni Lu ◽  
...  
Keyword(s):  
Supportive Care ◽  
Cancer Patients ◽  
Financial Distress ◽  
Comprehensive Cancer Center ◽  
Multivariate Logistic Regression Model ◽  
Cancer Center ◽  
Opioid Use ◽  
Care Clinic ◽  
Validated Questionnaire ◽  
Edmonton Symptom Assessment Scale

11602 Background: Non-Medical opioid use is a growing crisis. Cancer patients at risk of harmful use of prescribed opioids are frequently underdiagnosed. The aim was to develop a nomogram to predict the probability of occurrence of Inappropriate opioid use that is, presence of SOAPP ≥ 7) among patients receiving outpatient supportive care consultation at a comprehensive cancer center. Methods: 3588 consecutive cancer patients referred to a supportive care clinic from March 1, 2016 to July 15, 2018 were reviewed. Patients were eligible if they had diagnosis of cancer, and were on opioids for pain for at least a week. All patients were assessed using Edmonton Symptom Assessment Scale with spiritual pain and financial distress (ESAS-FS), MEDD (morphine equivalent daily dose), SOAPP-14 (validated questionnaire for assessment of risk of inappropriate opioid use, and CAGE-AID (screening questionnaire for alcoholism/substance use disorder). Patients at with SOAPP+ were defined by SOAPP score ≥7. A nomogram was devised based on the risk factors determined in the multivariate logistic regression model and it can be used to estimate the probability of inappropriate opioid use. Results: Median age was 62yrs. Median ESAS pain item score on consultation was 5, Median ECOG was 2.20.4% were SOAPP+ and 10.1% were CAGE-AID+. SOAPP+ was significantly associated with gender, race, marital status, smoking status, depression, anxiety, financial distress, MEDD and CAGE score. The C-index is 0.8(CI 0.78, 0.82). A nomogram was developed. For example, for a male Hispanic patient, who is married, never smoked, with the following ESAS scores: (depression = 3, anxiety = 3, financial distress = 8), CAGE score of 0, and MEDD of 20, the total score is 9+9+0+0+6+10+26+0+1 = 61. In the nomogram a score of 58 indicates the probability of inappropriate opioid use being 0.1 and a score of 88 indicates the probability of 0.2. Based on the patient’s total score of 61, the probability of his aberrant behavior is between 10% to 20% (close to 10%). Conclusions: A nomogram can predict the risk of inappropriate opioid use in cancer patients.

The development of a nomogram to determine the frequency of elevated risk for non-medical opioid use in cancer patients

2020 ◽  
pp. 1-8 ◽  
Author(s):  
Sriram Yennurajalingam ◽  
Tonya Edwards ◽  
Joseph Arthur ◽  
Zhanni Lu ◽  
Elif Erdogan ◽  
...  
Keyword(s):  
Supportive Care ◽  
Cancer Patients ◽  
Financial Distress ◽  
Elevated Risk ◽  
Comprehensive Cancer Center ◽  
Multivariate Logistic Regression Model ◽  
Cancer Center ◽  
Opioid Use ◽  
Care Clinic ◽  
Edmonton Symptom Assessment Scale

Abstract Objective Non-medical opioid use (NMOU) is a growing crisis. Cancer patients at elevated risk of NMOU (+risk) are frequently underdiagnosed. The aim of this paper was to develop a nomogram to predict the probability of +risk among cancer patients receiving outpatient supportive care consultation at a comprehensive cancer center. Method 3,588 consecutive patients referred to a supportive care clinic were reviewed. All patients had a diagnosis of cancer and were on opioids for pain. All patients were assessed using the Edmonton Symptom Assessment Scale (ESAS), Screener and Opioid Assessment for Patients with Pain (SOAPP-14), and CAGE-AID (Cut Down-Annoyed-Guilty-Eye Opener) questionnaires. “+risk” was defined as an SOAPP-14 score of ≥7. A nomogram was devised based on the risk factors determined by the multivariate logistic regression model to estimate the probability of +risk. Results 731/3,588 consults were +risk. +risk was significantly associated with gender, race, marital status, smoking status, depression, anxiety, financial distress, MEDD (morphine equivalent daily dose), and CAGE-AID score. The C-index was 0.8. A nomogram was developed and can be accessed at https://is.gd/soappnomogram. For example, for a male Hispanic patient, married, never smoked, with ESAS scores for depression = 3, anxiety = 3, financial distress = 7, a CAGE score of 0, and an MEDD score of 20, the total score is 9 + 9+0 + 0+6 + 10 + 23 + 0+1 = 58. A nomogram score of 58 indicates the probability of +risk of 0.1. Significance of results We established a practical nomogram to assess the +risk. The application of a nomogram based on routinely collected clinical data can help clinicians establish patients with +risk and positively impact care planning.

Blocking Is Sensitive to Causal Structure in 4-Year-Old and 8-Year-Old Children

2005 ◽  
Vol 52 (4) ◽  
pp. 264-271 ◽  
Author(s):  
Tom Beckers ◽  
Uschi Van den Broeck ◽  
Marij Renne ◽  
Stefaan Vandorpe ◽  
Jan De Houwer ◽  
...  
Keyword(s):  
Young Children ◽  
Associative Learning ◽  
Learning Theory ◽  
Causal Structure ◽  
Age Groups ◽  
Learning Task ◽  
Contingency Learning

Abstract. In a contingency learning task, 4-year-old and 8-year-old children had to predict the outcome displayed on the back of a card on the basis of cues presented on the front. The task was embedded in either a causal or a merely predictive scenario. Within this task, either a forward blocking or a backward blocking procedure was implemented. Blocking occurred in the causal but not in the predictive scenario. Moreover, blocking was affected by the scenario to the same extent in both age groups. The pattern of results was similar for forward and backward blocking. These results suggest that even young children are sensitive to the causal structure of a contingency learning task and that the occurrence of blocking in such a task defies an explanation in terms of associative learning theory.

scholarly journals Diagnosed with a Rare Cancer: Experiences of Adult Sarcoma Survivors with the Healthcare System—Results from the SURVSARC Study

Cancers ◽  
2021 ◽  
Vol 13 (4) ◽  
pp. 679
Author(s):  
Cas Drabbe ◽  
Dirk J. Grünhagen ◽  
Winan J. Van Houdt ◽  
Pètra M. Braam ◽  
Vicky L. M. N. Soomers ◽  
...  
Keyword(s):  
Supportive Care ◽  
Healthcare System ◽  
Support Groups ◽  
Information Needs ◽  
Age Groups ◽  
Satisfaction With Care ◽  
Rare Cancer ◽  
Questionnaire Response ◽  
Care Information ◽  
Diagnostic Intervals

The aim of this study was to explore the experience of rare cancer patients with the healthcare system and examine differences between age groups (adolescents and young adults (AYA, 18–39 years), older adults (OA, 40–69 years) and elderly (≥70 years)). Dutch sarcoma patients, 2–10 years after diagnosis, completed a questionnaire on their experience with the healthcare system, satisfaction with care, information needs, patient and diagnostic intervals (first symptom to first doctor’s visit and first doctor’s visit to diagnosis, respectively) and received supportive care. In total, 1099 patients completed the questionnaire (response rate 58%): 186 AYAs, 748 OAs and 165 elderly. Many survivors experienced insufficient medical and non-medical guidance (32% and 38%), although satisfaction with care was rated good to excellent by 94%. Both patient and diagnostic intervals were >1 month for over half of the participants and information needs were largely met (97%). AYAs had the longest patient and diagnostic intervals, experienced the greatest lack of (non-)medical guidance, had more desire for patient support groups and used supportive care most often. This nationwide study among sarcoma survivors showed that healthcare experiences differ per age group and identified needs related to the rarity of these tumors, such as improvements concerning (non-)medical guidance and diagnostic intervals.

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