THE EFFECT OF A MEDICAL DECOMPRESSION PROTOCOL ON THE USE OF ANTIEMETICS, NASOGASTRIC TUBE USAGE AND DIET ADVANCE IN LATE STAGE CANCER PATIENTS WITH FUNCTIONAL INTESTINAL OBSTRUCTION

Background: At the end of life, many cancer patients suffer from a syndrome that simulates classic small bowel obstruction. The traditional approach to intestinal obstruction is relief of pressure in the gastrointestinal tract using mechanical methods. The Medical Decompression(MD) protocol is a non-invasive pharmacologic approach for this problem that is easy and economical. Methods: The study was done in a academic institution of central India from April 2019 to October 2019. It included 21 cases based on the inclusion and exclusion criteria. Data regarding demographics, cancer diagnosis, existing drug history and diet history was collected and the sample was randomly divided into two groups: one received medical decompression and the other didn’t. The data was compared using t-tests on the outcome variable days to advanced diet. Results: Out of 21 cases, 43% were males whereas 57% were females with a mean age of 66 years. About 30% of these had a pre-inserted NG tube. Around 19% of these were already on a clear liquid diet. Most men had colon cancer whereas most females had ovarian cancer. A mean of 1.1 doses and 3.8 days was taken to advance the diet. There was a statistically significant difference between the MD and the non MD group. Conclusions: A pharmacologic method such as MD is strongly useful as first line treatments for the functional intestinal obstruction syndrome and indeed be considered as adjuncts to allow the removal of invasive mechanical interventions in the end of life patient.

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Aggressive care at the end of life: A study of practice based factors in patients with stage IV cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.8_suppl.80 ◽

2017 ◽

Vol 35 (8_suppl) ◽

pp. 80-80

Author(s):

Mohammad Omar Atiq ◽

Rahul Ravilla ◽

Ajay Kumar ◽

Sajjad Haider ◽

Ji-Ling Tang ◽

...

Keyword(s):

Palliative Care ◽

Length Of Stay ◽

End Of Life ◽

Cancer Patients ◽

Stage Iv ◽

Goals Of Care ◽

Significant Difference ◽

Aggressive Care ◽

Stage Iv Cancer ◽

End Stage

80 Background: Numerous studies established that early utilization of palliative care-hospice services are beneficial to cancer patients. To reduce the incidence of aggressive care in terminal cancer patients, we conducted a quality improvement study to identify pertinent risk factors and develop interventions. Methods: Through chart review, we retrospectively identified patients with stage IV cancer that were followed by oncology clinic and were admitted to the University Hospital between 8/1/2015-10/31/15. For those patients who died during the last hospitalization or were discharged to hospice care, we obtained demographic, cancer related and practice related variables listed in Table. We used Mann Whitney U test and multivariable regression to find effects of factors related to length of stay (LOS) and cost of stay (COS). Results: Length of stay was significantly prolonged in those receiving chemotherapy within the past month (6 vs 3 p=0.035). Multivariate analyses found that patients with goals of care documented in the clinic had lower COS by 36.7% and LOS by 46.7%. On average, an ICU stay resulted in COS 2.2 times higher. No significant difference was seen in LOS based on a documented palliative care clinic visit or presence of an advanced directive. Conclusions: We identified practice based factors that need improvement including earlier goals of care conversations and less chemotherapy at the end of life. Identifying end stage patients in earlier admissions, collaborating with palliative care, and adding goals of care documentation to clinic note templates, are all interventions we are studying to improve care for end stage cancer patients. [Table: see text]

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Machine learning analysis on American Gut Project microbiome data to identify subjects with cancer both with and without chemotherapy exposure.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e14069 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e14069-e14069

Author(s):

Oguz Akbilgic ◽

Ibrahim Karabayir ◽

Hakan Gunturkun ◽

Joseph F Pierre ◽

Ashley C Rashe ◽

...

Keyword(s):

Machine Learning ◽

Cancer Patients ◽

Test Data ◽

Gut Microbiome ◽

Classification Model ◽

Outcome Variable ◽

Gradient Boosting ◽

Healthy Controls ◽

Extreme Gradient Boosting ◽

Significant Difference

e14069 Background: There is growing interest in the links between cancer and the gut microbiome. However, the effect of chemotherapy upon the gut microbiome remains unknown. We studied whether machine learning can: 1) accurately classify subjects with cancer vs healthy controls and 2) whether this classification model is affected by chemotherapy exposure status. Methods: We used the American Gut Project data to build a extreme gradient boosting (XGBoost) model to distinguish between subjects with cancer vs healthy controls using data on simple demographics and published microbiome. We then further explore the selected features for cancer subjects based on chemotherapy exposure. Results: The cohort included 7,685 subjects consisting of 561 subjects with cancer, 52.5% female, 87.3% White, and average age of 44.7 (SD 17.7). The binary outcome variable represents cancer status. Among 561 subjects with cancer, 94 of them were treated with chemotherapy agents before sampling of microbiomes. As predictors, there were four demographic variables (sex, race, age, BMI) and 1,812 operational taxonomic units (OTUs) each found in at least 2 subjects via RNA sequencing. We randomly split data into 80% training and 20% hidden test. We then built an XGBoost model with 5-fold cross-validation using only training data yielding an AUC (with 95% CI) of 0.79 (0.77, 0.80) and obtained the almost the same AUC on the hidden test data. Based on feature importance analysis, we identified 12 most important features (Age, BMI and 12 OTUs; 4C0d-2, Brachyspirae, Methanosphaera, Geodermatophilaceae, Bifidobacteriaceae, Slackia, Staphylococcus, Acidaminoccus, Devosia, Proteus) and rebuilt a model using only these features and obtained AUC of 0.80 (0.77, 0.83) on the hidden test data. The average predicted probabilities for controls, cancer patients who were exposed to chemotherapy, and cancer patients who were not were 0.071 (0.070,0.073), 0.125 (0.110, 0.140), 0.156 (0.148, 0.164), respectively. There was no statistically significant difference on levels of these 12 OTUs between cancer subjects treated with and without chemotherapy. Conclusions: Machine learning achieved a moderately high accuracy identifying patients’ cancer status based on microbiome. Despite the literature on microbiome and chemotherapy interaction, the levels of 12 OTUs used in our model were not significantly different for cancer patients with or without chemotherapy exposure. Testing this model on other large population databases is needed for broader validation.

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HSR19-087: Intensity of Symptom Management After Palliative Care Referral Not Associated With Reduced Imaging Intensity for Cancer Patients During the End-of-Life Period

Journal of the National Comprehensive Cancer Network ◽

10.6004/jnccn.2018.7167 ◽

2019 ◽

Vol 17 (3.5) ◽

pp. HSR19-087

Author(s):

Benjamin L. Franc ◽

Kesav Raghavan ◽

Timothy P. Copeland ◽

Maya Ladenheim ◽

Angela Marks ◽

...

Keyword(s):

Palliative Care ◽

End Of Life ◽

Cancer Patients ◽

Symptom Management ◽

Chi Square ◽

Intensity Score ◽

Life Period ◽

Significant Difference ◽

Management Intensity ◽

Imaging Utilization

Purpose: For patients with advanced cancer, palliative care (PC) referral itself results in improved quality of life and lower total health care costs. While our earlier research suggests that PC referral alone does not appear to affect imaging utilization, the effect of the intensity of services for PC symptom management on utilization of imaging services is unknown. We sought to evaluate whether an association exists between the intensity of PC symptom management services and utilization of high-cost imaging at the end-of-life. Methods/Materials: Adult cancer patients who died between January 1, 2012–May 31, 2015 were identified. A PC symptom management intensity score was determined for each patient during the last year of life based upon the number of inpatient and outpatient PC service visits and the number of problems addressed within the 8 defined domains for palliative care. Frequency of utilization of nonemergent oncologic imaging was determined for the last 3 months and the last month of life. Using chi-square and Wilcoxon-rank sum tests, effects of low (<20th percentile) and high (>80th percentile) PC symptom management intensity score on the proportion of patients imaged and mean number of studies per patient (mean imaging intensity [MII]) were compared for the last 3 months and last month of life. Results: 3,772 decedents were included, with 3,523 (93.4%) never referred to PC and 249 (6.6%) referred to PC, largely before the last month of life (70.3%). Within the last 3 months and last month of life, the proportion of patients imaged was significantly greater (P<.001) in patients with high PC symptom management intensity scores when compared to those with low PC symptom management intensity scores. There was no significant difference in the mean number of imaging studies received by either group in the last 1 month or 3 months of life. (P>.05). Conclusions: The intensity of PC symptom management in end-of-life oncologic care was not associated with decreased use of nonemergent, high-cost cancer imaging in our cohort. This may suggest an opportunity for reduced high-cost imaging through further clarification of the goals of care with both patients and oncologists, although the role of imaging in the setting of PC during the end-of-life period warrants further study as well.

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VARIATION IN ADVANCE DIRECTIVES TIMING BETWEEN END-STAGE RENAL DISEASE PATIENTS AND CANCER PATIENTS

Innovation in Aging ◽

10.1093/geroni/igz038.1018 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S275-S275

Author(s):

Yu-Hsuan Wang ◽

Susan Enguidanos

Keyword(s):

Renal Disease ◽

End Of Life ◽

Cancer Patients ◽

End Stage Renal Disease ◽

The United States ◽

Completion Rates ◽

Significant Difference ◽

Stage Renal Disease ◽

End Stage ◽

Esrd Patients

Abstract The United States has the third highest prevalence and the second highest incidence of End-Stage Renal Disease (ESRD). ESRD is associated with high mortality and lower quality of end-of-life experiences. Having an advance directive (AD) is associated with better care at the end of life. Although past ACP completion rates in ESRD patients has been studied, little is known about its timing differences between ESRD and cancer patients. This study investigates the timing difference of AD completion between ESRD and cancer patients We conducted logistic regression to analyze data from the Health and Retirement Study, a nationally representative longitudinal survey of older adults. The analytic sample included exit interviews from 2012 to 2016 among 971 proxies of deceased with ESRD or cancer. Among the sample, 47% of decedents completed an AD; 44% of cancer patients and 48% of ESRD patients. Being a racial minority (OR=0.38, p<0.001), and lower education (OR= 0.63, p=0.001) were associated with lower AD completion rates. No significant differences in AD completion rates were found between cancer patients and ESRD patients. Compared to cancer patients, ESRD patients were more likely to complete ADs more than one year before death (OR=3.15, p=0.001). However, there were no significant difference between cancer patients and ESRD patients in AD completion rates in the three months before death. Although both samples had comparable rates of AD completion, compared to cancer patients, ESRD patients tend to document care preferences earlier. Further studies are needed to investigate factors related to early documentation of ADs.

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