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LeBlanc, Thomas William

Overview:

Dr. LeBlanc is a medical oncologist, palliative care physician, and researcher.  His clinical practice focuses on the care of patients with hematologic malignancies, with a particular emphasis on myeloid conditions and acute leukemias including acute myeloid leukemia (AML), acute lymphocytic leukemia (ALL), myelodysplastic syndromes (MDS), and myeloproliferative neoplasms (MPNs / MPDs, CML), as well as some lymphomas and multiple myeloma.  He is an active member of the inpatient non-transplant hematologic malignancies care team, based on the 9100 ward of Duke Hospital.

His research interests converge on common issues faced by patients with cancer, particularly those with high-risk or relapsed/refractory hematologic malignancies. Issues of symptom burden and quality of life are of central importance in these settings, and may lead patients to face difficult decision-making scenarios. Dr. LeBlanc’s research explores the experience of patients and families in these settings, and aims to improve the experience of patients with blood cancers, including the involvement of specialist palliative care services as part of their comprehensive cancer care, even alongside active cancer-directed therapy.  

Dr. LeBlanc is the recipient of a Junior Career Development Award grant from the National Palliative Care Research Center (NPCRC). This grant funded his efforts to better understand the experience of patients with AML, including symptom burden, quality of life, and understanding of prognosis. This work has been mentored by a team of expert researchers, including Drs. Amy Abernethy, James Tulsky, Karen Steinhauser, Kath Pollak, and Peter Ubel.  Dr. LeBlanc's work in palliative care research led to his recognition as an "Inspirational Leader under 40" by the American Academy of Hospice and Palliative Medicine (AAHPM). Dr. LeBlanc subsequently received a Sojourns Scholars Leadership Award from the Cambia Health Foundation, facilitating his career development as a palliative care expert for patients with hematologic malignancies, and a Mentored Research Scholar Grant from the American Cancer Society to fund his work to improve patients' experiences when making a treatment decision about AML. He is chair-elect of the Ethics Committee of the American Society of Clinical Oncology, and sits on the Scientific Review Committee of the NIH-funded Palliative Care Research Cooperative Group.  He also represents the Duke Cancer Institute, a National Comprehensive Cancer Network (NCCN) member, on the NCCN panel for cancer-related fatigue, and was granted "Fellow" status by the AAHPM in 2016.

He completed residency training in Internal Medicine at Duke, as well as fellowships in Medical Oncology and Hospice and Palliative Medicine.  He graduated from the Duke University School of Medicine, also earning a Master of Arts degree in Philosophy during that time, and served as Chief Medical Resident at the Durham VA Medical Center.  He holds board certifications in Internal Medicine, Medical Oncology, and in Hospice and Palliative Medicine.  He is actively involved with teaching of medical students and housestaff at Duke, particularly with regards to issues of patient-doctor communication, and is mentoring several Duke trainees on research projects.

Positions:

Associate Professor of Medicine

Medicine, Hematological Malignancies
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

M.D. 2006

M.D. — Duke University

Grants:

Prognostic understanding and decision-making in acute myeloid leukemia (AML)

Administered By
Duke Cancer Institute
AwardedBy
American Cancer Society, Inc.
Role
Principal Investigator
Start Date
January 01, 2016
End Date
December 31, 2019

Caregiver-Guided Pain Management Training in Palliative Care

Administered By
Psychiatry & Behavioral Sciences, Behavioral Medicine
AwardedBy
National Institutes of Health
Role
Co Investigator
Start Date
September 26, 2014
End Date
June 30, 2018

Refinement and Expansion of the Palliative Care Research Cooperative Group

Administered By
Duke Cancer Institute
AwardedBy
National Institutes of Health
Role
Investigator
Start Date
September 28, 2013
End Date
June 30, 2018

Palliative care and shared decision-making for patients with blood cancers

Administered By
Duke Cancer Institute
AwardedBy
Cambia Health Foundation
Role
Principal Investigator
Start Date
October 01, 2015
End Date
October 01, 2017

TRIADIC EXPECTATIONS: DECISION-MAKING IN ADVANCED CANCER

Administered By
Medicine, General Internal Medicine
AwardedBy
National Palliative Care Research Center
Role
Significant Contributor
Start Date
July 01, 2014
End Date
June 30, 2017

Prognostic Discordance in Oncology: what's behind the misunderstanding?

Administered By
Duke Clinical Research Institute
AwardedBy
National Palliative Care Research Center
Role
Principal Investigator
Start Date
July 01, 2013
End Date
June 30, 2015
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Publications:

Concordance Between Veterans' Self-Report and Documentation of Surrogate Decision Makers: Implications for Quality Measurement

Authors
Garner, KK; Dubbert, P; Lensing, S; Sullivan, DH; Aslakson, RA; Ast, K; Elk, R; Garner, KK; Gramling, R; Grudzen, C; Kamal, AH; Lamba, S; LeBlanc, TW; Rhodes, RL; Roeland, E; Schulman-Green, D; Unroe, KT
MLA Citation
Garner, KK, Dubbert, P, Lensing, S, Sullivan, DH, Aslakson, RA, Ast, K, Elk, R, Garner, KK, Gramling, R, Grudzen, C, Kamal, AH, Lamba, S, LeBlanc, TW, Rhodes, RL, Roeland, E, Schulman-Green, D, and Unroe, KT. "Concordance Between Veterans' Self-Report and Documentation of Surrogate Decision Makers: Implications for Quality Measurement." Journal of Pain and Symptom Management 53.1 (January 2017): 1-4.
Source
crossref
Published In
Journal of Pain and Symptom Management
Volume
53
Issue
1
Publish Date
2017
Start Page
1
End Page
4
DOI
10.1016/j.jpainsymman.2016.10.356

Risk stratification, treatment selection, and transplant eligibility in multiple myeloma: a qualitative study of the perspectives and self-reported practices of oncologists.

Since the early 2000s, treatment options for multiple myeloma have rapidly expanded, adding significant complexity to the management of this disease. To our knowledge, no systematic qualitative research on clinical decision-making in multiple myeloma has been published. We sought to characterize how physicians view and implement guidelines and incorporate novel approaches into patient care.We designed a semi-structured qualitative interview guide informed by literature review and an expert advisory panel. We conducted 60-minute interviews with a diverse sample of oncology physicians in the southeast United States. We used a constant comparative method to code and analyze interview transcripts. The research team and advisory panel discussed and validated emergent themes.Participants were 13 oncologists representing 5 academic and 4 community practices. Academic physicians reported using formal risk-stratification schemas; community physicians typically did not. Physicians also described differences in eligibility criteria for transplantation; community physicians emphasized distance, social support, and psychosocial capacity in making decisions about transplantation referral; the academic physicians reported using more specific clinical criteria. All physicians reported using a maintenance strategy both for post-transplant and for transplant-ineligible patients; however, determining the timing of maintenance therapy initiation and the response were reported as challenging, as was recognition or definition of relapse, especially in terms of when treatment re-initiation is indicated.Practices reported by both academic and community physicians suggest opportunities for interventions to improve patient care and outcomes through optimal multiple myeloma management and therapy selection. Community physicians in particular might benefit from targeted education interventions about risk stratification, transplant eligibility, and novel therapies.

Authors
LeBlanc, TW; Howson, A; Turell, W; Sheldon, P; Locke, SC; Tuchman, SA; Gasparetto, C; Kaura, S; Khan, ZM; Abernethy, AP
MLA Citation
LeBlanc, TW, Howson, A, Turell, W, Sheldon, P, Locke, SC, Tuchman, SA, Gasparetto, C, Kaura, S, Khan, ZM, and Abernethy, AP. "Risk stratification, treatment selection, and transplant eligibility in multiple myeloma: a qualitative study of the perspectives and self-reported practices of oncologists." Current oncology (Toronto, Ont.) 23.6 (December 21, 2016): e598-e604.
PMID
28050150
Source
epmc
Published In
Current oncology (Toronto, Ont.)
Volume
23
Issue
6
Publish Date
2016
Start Page
e598
End Page
e604
DOI
10.3747/co.23.3298

Palliative and End-of-Life Care in Myelodysplastic Syndromes.

A growing literature demonstrates that MDS is associated with significant impairments in overall quality of life. Given the poor prognosis for many patients with MDS, and the considerable morbidities associated with this disease, there is a critical need to address palliative and end-of-life care needs in this population. However, palliative and end-of-life care issues are under-represented in the MDS literature. In this article, we highlight a growing body of literature that demonstrates unmet palliative and end-of-life care needs in hematologic malignancies, including MDS, and highlight opportunities for further research and quality improvement initiatives to address unmet needs in MDS care.

Authors
Nickolich, M; El-Jawahri, A; LeBlanc, TW
MLA Citation
Nickolich, M, El-Jawahri, A, and LeBlanc, TW. "Palliative and End-of-Life Care in Myelodysplastic Syndromes." Current hematologic malignancy reports 11.6 (December 2016): 434-440. (Review)
PMID
27704467
Source
epmc
Published In
Current Hematologic Malignancy Reports
Volume
11
Issue
6
Publish Date
2016
Start Page
434
End Page
440
DOI
10.1007/s11899-016-0352-z

Adherence to Measuring What Matters Items When Caring for Patients With Hematologic Malignancies Versus Solid Tumors.

Measuring What Matters (MWM) prioritizes quality measures in palliative care practice. Hematologic malignancy patients are less likely to access palliative care, yet little is known about their unique needs. Differences in MWM adherence may highlight opportunities to improve palliative care in hematology.To assess adherence to MWM measures by palliative care clinicians caring for patients with hematologic malignancies, compared to those with solid tumors.We used the Quality Data Collection Tool to assess completion of MWM measures across nine sites.We included data from 678 patients' first visits and various care settings; 64 (9.4%) had a hematologic malignancy, whereas 614 (90.6%) had a solid tumor. Hematology patients were more likely to be seen in a hospital (52 or 81.3% vs. 420 or 68%), whereas solid tumor patients were more frequently seen at home or in clinics (160 or 26% vs. 7 or 10.9%). Of the nine MWM measures we assessed, high adherence (>90%) was seen regardless of tumor type in measures #3 (Pain Treatment), #7 (Spiritual Concerns), #8 (Treatment Preferences), and #9 (Care Consistent With Preferences). Clinicians seeing hematology patients were significantly less likely to meet measures #2 (Screening for Physical Symptoms; 57.8% vs. 84.2%, P < 0.001), and #5 (Discussion of Emotional Needs; 56.3% vs. 70.0%, P = 0.03).MWM adherence regarding symptom assessment and meeting emotional needs was lower for patients with hematologic malignancies compared to those with solid tumors. This finding suggests two key areas for quality improvement initiatives in palliative care for patients with hematologic malignancies.

Authors
LeBlanc, TW; Ritchie, CS; Friedman, F; Bull, J; Kutner, JS; Johnson, KS; Kamal, AH
MLA Citation
LeBlanc, TW, Ritchie, CS, Friedman, F, Bull, J, Kutner, JS, Johnson, KS, and Kamal, AH. "Adherence to Measuring What Matters Items When Caring for Patients With Hematologic Malignancies Versus Solid Tumors." Journal of pain and symptom management 52.6 (December 2016): 775-782.
PMID
27810570
Source
epmc
Published In
Journal of Pain and Symptom Management
Volume
52
Issue
6
Publish Date
2016
Start Page
775
End Page
782
DOI
10.1016/j.jpainsymman.2016.09.004

Patient experiences of acute myeloid leukemia: A qualitative study about diagnosis, illness understanding, and treatment decision-making.

Patients with acute myeloid leukemia (AML) face a unique, difficult situation characterized by sudden changes in health, complex information, and pressure to make quick treatment decisions amid sizeable tradeoffs. Yet, little is known about patients' experiences with AML. We used qualitative methods to learn about their experiences with diagnosis and treatment decision-making to identify areas for improvement.We recruited hospitalized patients with AML to participate in semi-structured qualitative interviews about their experiences being diagnosed with AML, receiving information, and making a treatment decision. Interviews were conducted during their hospitalization for induction chemotherapy. We analyzed data by using a constant comparison approach.Thirty-two patients completed an interview. Four main themes emerged: (a) shock and suddenness, (b) difficulty processing information, (c) poor communication, and (d) uncertainty. Patients frequently described their diagnosis as shocking. They also felt that the amount of information was too great and too difficult to process, which negatively impacted their understanding. Patients frequently described a lack of emotional support from clinicians and described uncertainty about their prognosis, the number and nature of available treatments, and what to expect from treatment.Acute myeloid leukemia poses a sudden, emotionally challenging, information-laden situation, where little time is available to make important decisions. This results in difficulty processing information and is sometimes complicated by a lack of emotive communication from clinicians. Results indicate a need for targeted interventions to improve AML patients' understanding of illness and treatment options and to address their traumatic experiences around diagnosis.

Authors
LeBlanc, TW; Fish, LJ; Bloom, CT; El-Jawahri, A; Davis, DM; Locke, SC; Steinhauser, KE; Pollak, KI
MLA Citation
LeBlanc, TW, Fish, LJ, Bloom, CT, El-Jawahri, A, Davis, DM, Locke, SC, Steinhauser, KE, and Pollak, KI. "Patient experiences of acute myeloid leukemia: A qualitative study about diagnosis, illness understanding, and treatment decision-making." November 15, 2016.
PMID
27862591
Source
epmc
Published In
Psycho-Oncology
Publish Date
2016
DOI
10.1002/pon.4309

Anticholinergic Drug Burden in Noncancer Versus Cancer Patients Near the End of Life.

Anticholinergic drugs can cause several side effects, impairing cognition and quality of life (QOL). Cancer patients are often exposed to increasing cumulative anticholinergic load (ACL) as they approach death, but this burden has not been examined in patients with nonmalignant diseases.To determine ACL and its impact in noncancer versus cancer palliative care patients.We performed a secondary analysis of 244 subjects enrolled in a randomized controlled trial. ACL was quantified with the Anticholinergic Drug Scale. We used multivariable regression to calculate the effect of ACL on key outcomes, including drowsiness, fatigue, and QOL. Patients were stratified by diagnosis, and drugs were grouped as symptom management (SM) or disease management (DM).Overall, ACL in cancer and noncancer patients was not significantly different (2.6 vs. 2.4; P = 0.23). SM drugs caused greater anticholinergic exposure than DM drugs in both cancer and noncancer patients (2.3 vs. 0.5, and 1.5 vs. 1.3, respectively; both P < 0.05); however, DM drugs exposed noncancer patients to relatively more ACL than cancer patients (1.2 vs. 0.6, P < 0.0001). ACL was associated with worse fatigue (odds ratio, 1.08; CI, 1.002-1.17) and worse QOL (odds ratio, 0.89; CI, 0.80-0.98).ACL is associated with worse fatigue and QOL and may not differ significantly between cancer and noncancer patients nearing end of life. SM drugs are more responsible for ACL in cancer and noncancer patients, although DM drugs contribute significantly to ACL in the latter group. We recommend more attention to reducing anticholinergic use in all patients with life-limiting illness.

Authors
Hochman, MJ; Kamal, AH; Wolf, SP; Samsa, GP; Currow, DC; Abernethy, AP; LeBlanc, TW
MLA Citation
Hochman, MJ, Kamal, AH, Wolf, SP, Samsa, GP, Currow, DC, Abernethy, AP, and LeBlanc, TW. "Anticholinergic Drug Burden in Noncancer Versus Cancer Patients Near the End of Life." Journal of pain and symptom management 52.5 (November 2016): 737-743.e3.
PMID
27663186
Source
epmc
Published In
Journal of Pain and Symptom Management
Volume
52
Issue
5
Publish Date
2016
Start Page
737
End Page
743.e3
DOI
10.1016/j.jpainsymman.2016.03.020

Cancer Cachexia: Beyond Weight Loss.

Cancer cachexia is a multifactorial syndrome characterized by skeletal muscle loss leading to progressive functional impairment. Despite the ubiquity of cachexia in clinical practice, prevention, early identification, and intervention remain challenging. The impact of cancer cachexia on quality of life, treatment-related toxicity, physical function, and mortality are well established; however, establishing a clinically meaningful definition has proven challenging because of the focus on weight loss alone. Attempts to more comprehensively define cachexia through body composition, physical functioning, and molecular biomarkers, while promising, are yet to be routinely incorporated into clinical practice. Pharmacologic agents that have not been approved by the US Food and Drug Administration but that are currently used in cancer cachexia (ie, megestrol, dronabinol) may improve weight but not outcomes of interest such as muscle mass, physical activity, or mortality. Their routine use is limited by adverse effects. For the practicing oncologist, early identification and management of cachexia is critical. Oncologists must recognize cachexia beyond weight loss alone, focusing instead on body composition and physical functioning. In fact, becoming emaciated is a late sign of cachexia that characterizes its refractory stage. Given that cachexia is a multifactorial syndrome, it requires early identification and polymodal intervention, including optimal cancer therapy, symptom management, nutrition, exercise, and psychosocial support. Consequently, oncologists have a role in ensuring that these resources are available to their patients. In addition, in light of the promising investigational agents, it remains imperative to refer patients with cachexia to clinical trials so that available options can be expanded to effectively treat this pervasive problem.

Authors
Bruggeman, AR; Kamal, AH; LeBlanc, TW; Ma, JD; Baracos, VE; Roeland, EJ
MLA Citation
Bruggeman, AR, Kamal, AH, LeBlanc, TW, Ma, JD, Baracos, VE, and Roeland, EJ. "Cancer Cachexia: Beyond Weight Loss." Journal of oncology practice 12.11 (November 2016): 1163-1171.
PMID
27858548
Source
epmc
Published In
Journal of Oncology Practice
Volume
12
Issue
11
Publish Date
2016
Start Page
1163
End Page
1171

Effect of Inpatient Palliative Care on Quality of Life 2 Weeks After Hematopoietic Stem Cell Transplantation: A Randomized Clinical Trial.

During hospitalization for hematopoietic stem cell transplantation (HCT), patients receive high-dose chemotherapy before transplantation and experience significant physical and psychological symptoms and poor quality of life (QOL).To assess the effect of inpatient palliative care on patient- and caregiver-reported outcomes during hospitalization for HCT and 3 months after transplantation.Nonblinded randomized clinical trial among 160 adults with hematologic malignancies undergoing autologous/allogeneic HCT and their caregivers (n = 94). The study was conducted from August 2014 to January 2016 in a Boston hospital; follow-up was completed in May 2016.Patients assigned to the intervention (n=81) were seen by palliative care clinicians at least twice a week during HCT hospitalization; the palliative intervention was focused on management of physical and psychological symptoms. Patients assigned to standard transplant care (n=79) could be seen by palliative care clinicians on request.Primary: change in patient QOL from baseline to week 2; secondary: patient-assessed mood, fatigue, and symptom burden scores at baseline, 2 weeks, and 3 months after HCT and caregiver-assessed QOL and mood at baseline and 2 weeks after HCT.Among 160 enrolled patients (mean age, 60 [SD, 13.3] years; 91 women [56.9%]; median hospital stay, 21 days) and 94 caregivers, 157 (98.1%) and 89 (94.7%), respectively, completed 2-week follow-up, and 149 patients (93.1%) completed 3-month follow-up. Patients in the intervention group reported a smaller decrease in QOL from baseline to week 2 (mean baseline score, 110.26; week 2 score, 95.46; mean change, -14.72) compared with patients in the control group (mean baseline score, 106.83; week 2 score, 85.42; mean change, -21.54; difference between groups, -6.82; 95% CI, -13.48 to -0.16; P = .045). Among the secondary outcomes, from baseline to week 2, patients in the intervention group vs those in the control group had less increase in depression (mean, 2.43 vs 3.94; mean difference, 1.52; 95% CI, 0.23-2.81; P = .02), lower anxiety (mean, -0.80 vs 1.12; mean difference, 1.92; 95% CI, 0.83-3.01; P < .001), no difference in fatigue (mean, -10.30 vs -13.65; mean difference, -3.34; 95% CI, -7.25 to 0.56; P = .09), and less increase in symptom burden (mean, 17.35 vs 23.14; mean difference, 5.80; 95% CI, 0.49-11.10; P = .03). At 3 months after HCT, intervention patients vs control patients had higher QOL scores (mean, 112.00 vs 106.66; mean difference, 5.34; 95% CI, 0.04-10.65; P = .048) and less depression symptoms (mean, 3.49 vs 5.19; mean difference, -1.70; 95% CI, -2.75 to -0.65; P = .002) but no significant differences in anxiety, fatigue, or symptom burden. From baseline to week 2 after HCT, caregivers of patients in the intervention group vs caregivers of patients in the control group reported no significant differences in QOL or anxiety but had a smaller increase in depression (mean, 0.25 vs 1.80; mean difference, 1.55; 95% CI, 0.14-2.96; P = .03).Among adults at a single institution undergoing HCT for hematologic malignancy, the use of inpatient palliative care compared with standard transplant care resulted in a smaller decrease in QOL 2 weeks after transplantation. Further research is needed for replication and to assess longer-term outcomes and cost implications.clinicaltrials.gov Identifier: NCT02207322.

Authors
El-Jawahri, A; LeBlanc, T; VanDusen, H; Traeger, L; Greer, JA; Pirl, WF; Jackson, VA; Telles, J; Rhodes, A; Spitzer, TR; McAfee, S; Chen, Y-BA; Lee, SS; Temel, JS
MLA Citation
El-Jawahri, A, LeBlanc, T, VanDusen, H, Traeger, L, Greer, JA, Pirl, WF, Jackson, VA, Telles, J, Rhodes, A, Spitzer, TR, McAfee, S, Chen, Y-BA, Lee, SS, and Temel, JS. "Effect of Inpatient Palliative Care on Quality of Life 2 Weeks After Hematopoietic Stem Cell Transplantation: A Randomized Clinical Trial." JAMA 316.20 (November 2016): 2094-2103.
PMID
27893130
Source
epmc
Published In
JAMA : the journal of the American Medical Association
Volume
316
Issue
20
Publish Date
2016
Start Page
2094
End Page
2103
DOI
10.1001/jama.2016.16786

Association of Practice-Level Hospital Use With End-of-Life Outcomes, Readmission, and Weekend Hospitalization Among Medicare Beneficiaries With Cancer.

To determine the relationships between hospital use of treating oncology practices and patient outcomes.Retrospective analysis of 397,646 Medicare beneficiaries who received anticancer therapy in 2012. Each beneficiary was associated with a practice; practices were ranked on the basis of risk-adjusted hospital use, that is, inpatient intensity. Outcomes included 30-day readmission, weekend admissions, intensive care unit stays in the last month of life, and hospice stay of ≥ 7 days. Outcomes were measured for each quartile of practice-level inpatient intensity. We fit multivariable logistic regression models to calculate adjusted odds ratios (ORs) for each outcome for each quartile of inpatient intensity.Total 30-day readmissions were 22.8% and 31.9% (OR, 1.45; 95% CI, 1.39 to 1.50) for patients in practices with the lowest versus highest quartiles of inpatient intensity, respectively; unplanned readmissions were 19.8% and 27.1% (OR, 1.36; 95% CI, 1.31 to 1.41), respectively. The proportion of admissions that occurred on weekends was similar across quartiles. Patients of practices in the highest quartiles of inpatient intensity had higher rates of death in an ICU stay in the last month of life (25.5% versus 18.0%; OR, 1.33; 95% CI, 1.19 to 1.49) and a lower rate of hospice stay of at least 7 days (50.9% to 42.5%; OR, 0.79; 95% CI, 0.74 to 0.86).Medical oncology practices that seek to reduce hospitalizations should consider focusing initially on processes related to end-of-life care and care transitions.

Authors
Clough, JD; Strawbridge, LM; LeBlanc, TW; Hammill, BG; Kamal, AH
MLA Citation
Clough, JD, Strawbridge, LM, LeBlanc, TW, Hammill, BG, and Kamal, AH. "Association of Practice-Level Hospital Use With End-of-Life Outcomes, Readmission, and Weekend Hospitalization Among Medicare Beneficiaries With Cancer." Journal of oncology practice 12.10 (October 2016): e933-e943.
PMID
27531384
Source
epmc
Published In
Journal of Oncology Practice
Volume
12
Issue
10
Publish Date
2016
Start Page
e933
End Page
e943

Pretransplantation Supportive and Palliative Care Consultation for High-Risk Hematopoietic Cell Transplantation Patients.

Early palliative care (EPC) for patients with metastatic solid tumors is now standard of care, but the effect of EPC in hematopoietic cell transplantation (HCT) is less well understood. We studied the acceptability of pre-HCT EPC as measured by trial participation, changes in patient-reported outcomes, and follow-up with palliative care providers. English-speaking adults (age >17 years) with an HCT comorbidity index of ≥ 3, relapse risk > 25%, or planned HLA-mismatched allogeneic or myeloablative HCT received EPC before HCT admission with monthly or more frequent visits. Twenty-two (69%) of 32 subjects provided consent; 2 were later excluded (HCT cancelled, consent retracted) for a 63% participation rate. Comfort with EPC was high (82% very comfortable). Subjects reported stable or improved mood and sense of hope, without apparent negative effects with a median of 3 visits. Follow-up surveys were returned by 75% of participants at 60 days and by 65% at 90 days. Four (20%) were admitted to the intensive care unit before day 100 and 3 (15%) received life-support measures. Five (25%) died with median follow-up of 14 months. EPC is feasible, acceptable, and has the potential to improve the HCT experience, whether or not the patient survives. EPC for HCT patients should be tested in a randomized trial.

Authors
Loggers, ET; LeBlanc, TW; El-Jawahri, A; Fihn, J; Bumpus, M; David, J; Horak, P; Lee, SJ
MLA Citation
Loggers, ET, LeBlanc, TW, El-Jawahri, A, Fihn, J, Bumpus, M, David, J, Horak, P, and Lee, SJ. "Pretransplantation Supportive and Palliative Care Consultation for High-Risk Hematopoietic Cell Transplantation Patients." Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation 22.7 (July 2016): 1299-1305.
PMID
26976242
Source
epmc
Published In
Biology of Blood and Marrow Transplantation
Volume
22
Issue
7
Publish Date
2016
Start Page
1299
End Page
1305
DOI
10.1016/j.bbmt.2016.03.006

Better Palliative Care for All: Improving the Lived Experience With Cancer.

Authors
Kamal, AH; LeBlanc, TW; Meier, DE
MLA Citation
Kamal, AH, LeBlanc, TW, and Meier, DE. "Better Palliative Care for All: Improving the Lived Experience With Cancer." JAMA 316.1 (July 2016): 29-30.
PMID
27244674
Source
epmc
Published In
JAMA : the journal of the American Medical Association
Volume
316
Issue
1
Publish Date
2016
Start Page
29
End Page
30
DOI
10.1001/jama.2016.6491

Assessing Emotional Suffering in Palliative Care: Use of a Structured Note Template to Improve Documentation

Authors
Lamba, S; Berlin, A; Goett, R; Ponce, CB; Holland, B; Walther, S; Aslakson, RA; Ast, K; Elk, R; Garner, KK; Gramling, R; Grudzen, C; Kamal, AH; Lamba, S; LeBlanc, TW; Rhodes, RL; Roeland, E; Schulman-Green, D; Unroe, KT
MLA Citation
Lamba, S, Berlin, A, Goett, R, Ponce, CB, Holland, B, Walther, S, Aslakson, RA, Ast, K, Elk, R, Garner, KK, Gramling, R, Grudzen, C, Kamal, AH, Lamba, S, LeBlanc, TW, Rhodes, RL, Roeland, E, Schulman-Green, D, and Unroe, KT. "Assessing Emotional Suffering in Palliative Care: Use of a Structured Note Template to Improve Documentation." Journal of Pain and Symptom Management 52.1 (July 2016): 1-7.
Source
crossref
Published In
Journal of Pain and Symptom Management
Volume
52
Issue
1
Publish Date
2016
Start Page
1
End Page
7
DOI
10.1016/j.jpainsymman.2016.01.017

Potentially avoidable hospital admissions in older patients with acute myeloid leukaemia in the USA: a retrospective analysis.

Older adults (≥60 years of age) with acute myeloid leukaemia spend a substantial proportion of their life in hospital after diagnosis. We examined reasons for their hospital admissions and identified potentially avoidable hospital admissions (PAH) in this age group in the USA.In this retrospective analysis, we examined the reasons for hospital admissions in older patients diagnosed with and treated for acute myeloid leukaemia at two tertiary care hospitals in the USA. We included patients receiving intensive induction chemotherapy or non-intensive treatment. We excluded those with acute promyelocytic leukaemia, those seen only for a one-time consultation who received primary treatment elsewhere, and those who received supportive care alone. We identified the eligible cohort using the Dana-Farber Cancer Institute and Massachusetts General Hospital Leukemia Clinical Research Information Systems database. Practising oncologists used a consensus-driven medical record review process to identify the primary reason for each hospital admission and categorise it as potentially avoidable or not avoidable on the basis of an adaptation of Graham's criteria for PAH. We used multivariable logistic regression analyses to identify predictors of PAH.Between May 1, 2005, and Dec 23, 2011, we assessed 1040 hospital admissions (excluding initial admission for diagnosis) in 329 consecutively admitted patients. The most common primary reasons for hospital admissions were: fever or infection (396 [38%]), planned admission for chemotherapy or transplantation (391 [38%]), and uncontrolled symptoms (102 [10%]). We identified 172 (27%) of 649 unplanned hospital admissions as potentially avoidable; among these admissions, 82 (48%) were readmissions because of previous premature hospital discharge, 32 (19%) because of problems that could have been managed in the outpatient setting, and 26 (15%) because of failure of timely outpatient follow-up. In a mixed logistic regression model, higher education (odds ratio 1·43 [95% CI 1·01-2·00]; p=0·04) and receipt of non-intensive induction chemotherapy (1·97 [1·25-3·10]; p=0·003) were predictors of PAH.Although many hospital admissions in older patients with acute myeloid leukaemia are unavoidable and driven by the illness course and its treatment, a substantial proportion are potentially avoidable. Future interventions to reduce PAH in this population are clearly warranted.National Cancer Institute, National Palliative Care Research Center, and Cambia Health Foundation.

Authors
El-Jawahri, A; Keenan, T; Abel, GA; Steensma, DP; LeBlanc, TW; Chen, Y-B; Hobbs, G; Traeger, L; Fathi, AT; DeAngelo, DJ; Wadleigh, M; Ballen, KK; Amrein, PC; Stone, RM; Temel, JS
MLA Citation
El-Jawahri, A, Keenan, T, Abel, GA, Steensma, DP, LeBlanc, TW, Chen, Y-B, Hobbs, G, Traeger, L, Fathi, AT, DeAngelo, DJ, Wadleigh, M, Ballen, KK, Amrein, PC, Stone, RM, and Temel, JS. "Potentially avoidable hospital admissions in older patients with acute myeloid leukaemia in the USA: a retrospective analysis." The Lancet. Haematology 3.6 (June 2016): e276-e283.
PMID
27264037
Source
epmc
Published In
The Lancet. Haematology
Volume
3
Issue
6
Publish Date
2016
Start Page
e276
End Page
e283
DOI
10.1016/s2352-3026(16)30024-2

A practical measurement of thoracic sarcopenia: correlation with clinical parameters and outcomes in advanced lung cancer.

Thoracic sarcopenia can feasibly be measured from routine CT scans but does not correlate to patient-centred outcomes http://ow.ly/102UkQ.

Authors
Wysham, NG; Nipp, RD; LeBlanc, TW; Wolf, SP; Ekstrom, MP; Currow, DC
MLA Citation
Wysham, NG, Nipp, RD, LeBlanc, TW, Wolf, SP, Ekstrom, MP, and Currow, DC. "A practical measurement of thoracic sarcopenia: correlation with clinical parameters and outcomes in advanced lung cancer." ERJ open research 2.2 (April 13, 2016). (letter)
Website
http://hdl.handle.net/10161/13059
PMID
27730193
Source
epmc
Published In
ERJ Open Research
Volume
2
Issue
2
Publish Date
2016

An Exploratory Factor Analysis of the Scale Structure of the Patient Care Monitor Version 2.0.

The Patient Care Monitor (PCM), version 2.0, is an electronic patient-reported outcomes instrument designed to be embedded into oncology practices. One key psychometric component of an instrument is its factor structure.To validate the factor structure of the PCM.The PCM was administered within various oncology clinics at our institution from 2006 to 2011 as part of standard of care, yielding a large (n = 5624) and diverse data set. An exploratory factor analysis was performed.The PCM performed well in terms of missing values and floor and ceiling effects. The three scales postulated by the PCM developers exhibited high internal consistency (Cronbach alpha 0.94-0.95); the six subscales exhibited good internal consistency (Cronbach alpha 0.80-0.95). A three-factor model approximated simple structure and was consistent with the constructs of emotional function, physical function, and physical symptoms suggested by the PCM developers. However, a six-factor model did not support the division of these three constructs into subscales of despair, distress, ambulation, impaired performance, treatment side effects, and general physical symptoms. Instead, we observed an emotional factor, a physical functioning factor, a factor including many of the treatment side effects, and three factors consisting of various clusters of physical symptoms.Although six subscales postulated by its developers perform reasonably, allocation of the PCM items to three constructs is more accurate and likely more consistent with how symptoms and concerns are conceptualized by patients.

Authors
Samsa, GP; Wolf, S; LeBlanc, TW; Abernethy, AP
MLA Citation
Samsa, GP, Wolf, S, LeBlanc, TW, and Abernethy, AP. "An Exploratory Factor Analysis of the Scale Structure of the Patient Care Monitor Version 2.0." Journal of pain and symptom management 51.4 (April 2016): 776-783.e2.
PMID
26706623
Source
epmc
Published In
Journal of Pain and Symptom Management
Volume
51
Issue
4
Publish Date
2016
Start Page
776
End Page
783.e2
DOI
10.1016/j.jpainsymman.2015.11.013

Concordance of Advance Care Plans With Inpatient Directives in the Electronic Medical Record for Older Patients Admitted From the Emergency Department

Authors
Grudzen, CR; Buonocore, P; Steinberg, J; Ortiz, JM; Richardson, LD; Aslakson, RA; Ast, K; Elk, R; Garner, KK; Gramling, R; Grudzen, C; Kamal, AH; Lamba, S; LeBlanc, TW; Rhodes, RL; Roeland, E; Schulman-Green, D; Unroe, KT
MLA Citation
Grudzen, CR, Buonocore, P, Steinberg, J, Ortiz, JM, Richardson, LD, Aslakson, RA, Ast, K, Elk, R, Garner, KK, Gramling, R, Grudzen, C, Kamal, AH, Lamba, S, LeBlanc, TW, Rhodes, RL, Roeland, E, Schulman-Green, D, and Unroe, KT. "Concordance of Advance Care Plans With Inpatient Directives in the Electronic Medical Record for Older Patients Admitted From the Emergency Department." Journal of Pain and Symptom Management 51.4 (April 2016): 647-651.
Source
crossref
Published In
Journal of Pain and Symptom Management
Volume
51
Issue
4
Publish Date
2016
Start Page
647
End Page
651
DOI
10.1016/j.jpainsymman.2015.12.318

Adherence to Measuring What Matters Measures Using Point-of-Care Data Collection Across Diverse Clinical Settings.

Measuring What Matters (MWM) for palliative care has prioritized data collection efforts for evaluating quality in clinical practice. How these measures can be implemented across diverse clinical settings using point-of-care data collection on quality is unknown.To evaluate the implementation of MWM measures by exploring documentation of quality measure adherence across six diverse clinical settings inherent to palliative care practice.We deployed a point-of-care quality data collection system, the Quality Data Collection Tool, across five organizations within the Palliative Care Research Cooperative Group. Quality measures were recorded by clinicians or assistants near care delivery.During the study period, 1989 first visits were included for analysis. Our population was mostly white, female, and with moderate performance status. About half of consultations were seen on hospital general floors. We observed a wide range of adherence. The lowest adherence involved comprehensive assessments during the first visit in hospitalized patients in the intensive care unit (2.71%); the highest adherence across all settings, with an implementation of >95%, involved documentation of management of moderate/severe pain. We observed differences in adherence across clinical settings especially with MWM Measure #2 (Screening for Physical Symptoms, range 45.7%-81.8%); MWM Measure #5 (Discussion of Emotional Needs, range 46.1%-96.1%); and MWM Measure #6 (Documentation of Spiritual/Religious Concerns, range 0-69.6%).Variations in clinician documentation of adherence to MWM quality measures are seen across clinical settings. Additional studies are needed to better understand benchmarks and acceptable ranges for adherence tailored to various clinical settings.

Authors
Kamal, AH; Bull, J; Ritchie, CS; Kutner, JS; Hanson, LC; Friedman, F; Taylor, DH
MLA Citation
Kamal, AH, Bull, J, Ritchie, CS, Kutner, JS, Hanson, LC, Friedman, F, and Taylor, DH. "Adherence to Measuring What Matters Measures Using Point-of-Care Data Collection Across Diverse Clinical Settings." Journal of pain and symptom management 51.3 (March 2016): 497-503.
PMID
26854995
Source
epmc
Published In
Journal of Pain and Symptom Management
Volume
51
Issue
3
Publish Date
2016
Start Page
497
End Page
503
DOI
10.1016/j.jpainsymman.2015.12.313

Addressing End-of-Life Quality Gaps in Hematologic Cancers: The Importance of Early Concurrent Palliative Care.

Authors
LeBlanc, TW
MLA Citation
LeBlanc, TW. "Addressing End-of-Life Quality Gaps in Hematologic Cancers: The Importance of Early Concurrent Palliative Care." JAMA internal medicine 176.2 (February 2016): 265-266.
PMID
26720324
Source
epmc
Published In
JAMA Internal Medicine
Volume
176
Issue
2
Publish Date
2016
Start Page
265
End Page
266
DOI
10.1001/jamainternmed.2015.6994

Feeling Heard and Understood: A Patient-Reported Quality Measure for the Inpatient Palliative Care Setting.

As endorsed by the palliative care "Measuring What Matters" initiative, capturing patients' direct assessment of their care is essential for ongoing quality reporting and improvement. Fostering an environment where seriously ill patients feel heard and understood is of crucial importance to modern health care.To describe the development and performance of a self-report field measure for seriously ill patients to report how well they feel heard and understood in the hospital environment.As part of a larger ongoing cohort study of inpatient palliative care, we developed and administered the following point-of-care item: "Over the past two days, how much have you felt heard and understood by the doctors, nurses and hospital staff?" (completely, quite a bit, moderately, slightly, not at all). Participants completed the measure before and the day after palliative care consultation. For the postconsultation version, we changed the time frame from "past two days" to "today."One hundred sixty patients with advanced cancer completed the preconsultation assessment, and 87% of them completed the postconsultation version. Responses encompassed full use of the ordinal scale, did not exhibit ceiling or floor effects, and showed improvement from preassessment to postassessment. The item was quick to administer and easy for patients to complete.The "Heard & Understood" item is a promising self-report quality measure for the inpatient palliative care setting.

Authors
Gramling, R; Stanek, S; Ladwig, S; Gajary-Coots, E; Cimino, J; Anderson, W; Norton, SA; Aslakson, RA; Ast, K; Elk, R; Garner, KK; Gramling, R; Grudzen, C; Kamal, AH; Lamba, S; LeBlanc, TW; Rhodes, RL; Roeland, E; Schulman-Green, D; Unroe, KT
MLA Citation
Gramling, R, Stanek, S, Ladwig, S, Gajary-Coots, E, Cimino, J, Anderson, W, Norton, SA, Aslakson, RA, Ast, K, Elk, R, Garner, KK, Gramling, R, Grudzen, C, Kamal, AH, Lamba, S, LeBlanc, TW, Rhodes, RL, Roeland, E, Schulman-Green, D, and Unroe, KT. "Feeling Heard and Understood: A Patient-Reported Quality Measure for the Inpatient Palliative Care Setting." Journal of pain and symptom management 51.2 (February 2016): 150-154.
PMID
26596879
Source
epmc
Published In
Journal of Pain and Symptom Management
Volume
51
Issue
2
Publish Date
2016
Start Page
150
End Page
154
DOI
10.1016/j.jpainsymman.2015.10.018

Palliative chemotherapy: oxymoron or misunderstanding?

Oncologists routinely prescribe chemotherapy for patients with advanced cancer. This practice is sometimes misunderstood by palliative care clinicians, yet data clearly show that chemotherapy can be a powerful palliative intervention when applied appropriately. Clarity regarding the term "palliative chemotherapy" is needed: it is chemotherapy given in the non-curative setting to optimize symptom control, improve quality of life, and sometimes to improve survival. Unfortunately, oncologists lack adequate tools to predict which patients will benefit. In a study recently published in BMC Palliative Care, Creutzfeldt et al. presented an innovative approach to advancing the science in this area: using patient reported outcomes to predict responses to palliative chemotherapy. With further research, investigators may be able to develop predictive models for use at the bedside to inform clinical decision-making about the risks and benefits of treatment. In the meantime, oncologists and palliative care clinicians must work together to reduce the use of "end-of-life chemotherapy"-chemotherapy given close to death, which does not improve longevity or symptom control-while optimizing the use of chemotherapy that has true palliative benefits for patients.

Authors
Roeland, EJ; LeBlanc, TW
MLA Citation
Roeland, EJ, and LeBlanc, TW. "Palliative chemotherapy: oxymoron or misunderstanding?." BMC palliative care 15 (January 2016): 33-.
Website
http://hdl.handle.net/10161/13675
PMID
27000049
Source
epmc
Published In
BMC Palliative Care
Volume
15
Publish Date
2016
Start Page
33
DOI
10.1186/s12904-016-0109-4

Discussing the Evidence for Upstream Palliative Care in Improving Outcomes in Advanced Cancer.

Palliative care has received increasing attention at the American Society of Clinical Oncology (ASCO) Annual Meeting since the publication of its provisional clinical opinion on the topic in 2012. Despite frequent discussion, palliative care remains a source of some controversy and confusion in clinical practice, especially concerning who should provide it, what it encompasses, and when and how it can help patients and their families. In this article, we provide a formal definition of palliative care and review the state of the science of palliative care in oncology. Several randomized controlled trials now show that palliative care improves important outcomes for patients with cancer. Related outcome improvements include a reduction in symptoms, improved quality of life, better prognostic understanding, less depressed mood, less aggressive end-of-life care, reduced resource utilization, and even prolonged survival. As such, ASCO recommends early integration of palliative care into comprehensive cancer care for all patients with advanced disease and/or significant symptom burden. Our aim is that this summary will facilitate greater understanding about palliative care and encourage further integration of palliative care services into cancer care. More research is needed to illuminate the mechanisms of action of palliative care and to improve the specificity of palliative care applications to unique scenarios and populations in oncology.

Authors
Nickolich, MS; El-Jawahri, A; Temel, JS; LeBlanc, TW
MLA Citation
Nickolich, MS, El-Jawahri, A, Temel, JS, and LeBlanc, TW. "Discussing the Evidence for Upstream Palliative Care in Improving Outcomes in Advanced Cancer." American Society of Clinical Oncology educational book. American Society of Clinical Oncology. Meeting 35 (January 2016): e534-e538.
PMID
27249764
Source
epmc
Published In
American Society of Clinical Oncology educational book / ASCO. American Society of Clinical Oncology. Meeting
Volume
35
Publish Date
2016
Start Page
e534
End Page
e538
DOI
10.14694/edbk_159224

What bothers lung cancer patients the most? A prospective, longitudinal electronic patient-reported outcomes study in advanced non-small cell lung cancer.

Patients with advanced non-small cell lung cancer (aNSCLC) face a significant symptom burden. Little is known about the frequency and severity of symptoms over time, so we longitudinally characterized patients' symptoms using the Patient Care Monitor (PCM) version 2.0, an electronic symptom-assessment tool.Ninety-seven patients with aNSCLC completed the PCM at up to four clinic visits. We analyzed symptom data by incidence, severity, type (functional vs. nonfunctional), proximity to death, and cancer anorexia-cachexia syndrome status (CACS).Functional concerns predominated, even in the non-CACS group. Average severity among the top 5 symptoms was worse for functional than nonfunctional items (mean difference 0.62, 95% CI 0.22-1.01, P = 0.003). Severe dyspnea and fatigue were the most prevalent nonfunctional symptoms; moderate/severe dyspnea was reported by at least 29% of patients, and fatigue by over 50%. Depression was reported infrequently, with over half of patients at each visit reporting "none"; moderate or severe depression was reported in only 2.5-9.3 and 3.4-6.2% of patients, respectively. The average number of moderate/severe symptoms increased with proximity to death; 84% reported moderate/severe fatigue in the last 3 months of life, compared to 48% at ≥ 12 months from death (P = 0.007).Patients with aNSCLC face a significant symptom burden, which increases with proximity to death. Symptom type and severity vary by proximity to death, but even patients without overt CACS report significant functional symptoms throughout. We recommend an individualized approach to palliative symptom intervention in advanced lung cancer, based on detailed symptom assessment and tracking.

Authors
LeBlanc, TW; Nickolich, M; Rushing, CN; Samsa, GP; Locke, SC; Abernethy, AP
MLA Citation
LeBlanc, TW, Nickolich, M, Rushing, CN, Samsa, GP, Locke, SC, and Abernethy, AP. "What bothers lung cancer patients the most? A prospective, longitudinal electronic patient-reported outcomes study in advanced non-small cell lung cancer." Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer 23.12 (December 2015): 3455-3463.
PMID
25791391
Source
epmc
Published In
Supportive Care in Cancer
Volume
23
Issue
12
Publish Date
2015
Start Page
3455
End Page
3463
DOI
10.1007/s00520-015-2699-4

Chemotherapy Use, Performance Status, and Quality of Life at the End of Life.

Although many patients with end-stage cancer are offered chemotherapy to improve quality of life (QOL), the association between chemotherapy and QOL amid progressive metastatic disease has not been well-studied. American Society for Clinical Oncology guidelines recommend palliative chemotherapy only for solid tumor patients with good performance status.To evaluate the association between chemotherapy use and QOL near death (QOD) as a function of patients' performance status.A multi-institutional, longitudinal cohort study of patients with end-stage cancer recruited between September 2002 and February 2008. Chemotherapy use (n = 158 [50.6%]) and Eastern Cooperative Oncology Group (ECOG) performance status were assessed at baseline (median = 3.8 months before death) and patients with progressive metastatic cancer (N = 312) following at least 1 chemotherapy regimen were followed prospectively until death at 6 outpatient oncology clinics in the United States.Patient QOD was determined using validated caregiver ratings of patients' physical and mental distress in their final week.Chemotherapy use was not associated with patient survival controlling for clinical setting and patients' performance status. Among patients with good (ECOG score = 1) baseline performance status, chemotherapy use compared with nonuse was associated with worse QOD (odds ratio [OR], 0.35; 95% CI, 0.17-0.75; P = .01). Baseline chemotherapy use was not associated with QOD among patients with moderate (ECOG score = 2) baseline performance status (OR, 1.06; 95% CI, 0.51-2.21; P = .87) or poor (ECOG score = 3) baseline performance status (OR, 1.34; 95% CI, 0.46-3.89; P = .59).Although palliative chemotherapy is used to improve QOL for patients with end-stage cancer, its use did not improve QOD for patients with moderate or poor performance status and worsened QOD for patients with good performance status. The QOD in patients with end-stage cancer is not improved, and can be harmed, by chemotherapy use near death, even in patients with good performance status.

Authors
Prigerson, HG; Bao, Y; Shah, MA; Paulk, ME; LeBlanc, TW; Schneider, BJ; Garrido, MM; Reid, MC; Berlin, DA; Adelson, KB; Neugut, AI; Maciejewski, PK
MLA Citation
Prigerson, HG, Bao, Y, Shah, MA, Paulk, ME, LeBlanc, TW, Schneider, BJ, Garrido, MM, Reid, MC, Berlin, DA, Adelson, KB, Neugut, AI, and Maciejewski, PK. "Chemotherapy Use, Performance Status, and Quality of Life at the End of Life." JAMA oncology 1.6 (September 2015): 778-784.
PMID
26203912
Source
epmc
Published In
JAMA oncology
Volume
1
Issue
6
Publish Date
2015
Start Page
778
End Page
784
DOI
10.1001/jamaoncol.2015.2378

Validation and real-world assessment of the Functional Assessment of Anorexia-Cachexia Therapy (FAACT) scale in patients with advanced non-small cell lung cancer and the cancer anorexia-cachexia syndrome (CACS).

Patients with cancer anorexia-cachexia syndrome (CACS) suffer a significant symptom burden, impaired quality of life (QoL), and shorter survival. Measurement of QoL impairments related to CACS is thereby important both in clinical practice and in research. We aimed to further validate the Functional Assessment of Anorexia-Cachexia Therapy (FAACT) scale in an advanced lung cancer population.We tested the performance of the FAACT and its anorexia-cachexia subscale (ACS) within a dataset of patients with advanced non-small cell lung cancer (aNSCLC), using standard statistical methods. We then compared the performance of commonly used QoL measures stratified by CACS status and by patient self-report of appetite and weight loss.The FAACT and its ACS demonstrate internal validity consistent with acceptable published ranges for other QoL scales (Cronbach alpha = 0.9 and 0.79, respectively). Correlation coefficients demonstrate moderate correlations in the expected directions between FAACT and ACS and scales that measure related constructs. Comparing patients with and without CACS, the ACS is more sensitive to change than other QoL instruments (mean score 33.1 vs. 37.2, p = 0.011, ES = 0.58).In patients with aNSCLC, the FAACT and its ACS performed well compared with other instruments, further supporting their validity and value in clinical research. FAACT and ACS scores covaried with symptoms and other QoL changes that are typical hallmarks of CACS, lending further support to their use as QoL endpoints in clinical trials among patients with CACS.

Authors
LeBlanc, TW; Samsa, GP; Wolf, SP; Locke, SC; Cella, DF; Abernethy, AP
MLA Citation
LeBlanc, TW, Samsa, GP, Wolf, SP, Locke, SC, Cella, DF, and Abernethy, AP. "Validation and real-world assessment of the Functional Assessment of Anorexia-Cachexia Therapy (FAACT) scale in patients with advanced non-small cell lung cancer and the cancer anorexia-cachexia syndrome (CACS)." Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer 23.8 (August 2015): 2341-2347.
PMID
25586527
Source
epmc
Published In
Supportive Care in Cancer
Volume
23
Issue
8
Publish Date
2015
Start Page
2341
End Page
2347
DOI
10.1007/s00520-015-2606-z

Health care utilization and end-of-life care for older patients with acute myeloid leukemia.

Health care utilization in older adults (age ≥60 years) with acute myeloid leukemia (AML) has not been well studied.We conducted a retrospective analysis of 330 consecutive older patients who were diagnosed with AML between May 1, 2005 and December 23, 2011, at 2 hospitals in Boston to examine their health care utilization and end-of-life care. Using multivariable logistic and linear regression models adjusting for covariates, we also compared health care utilization between patients who received intensive induction chemotherapy (n = 197; cytarabine/ anthracycline combination) versus nonintensive chemotherapy (n = 133; single-agent therapy).The median number of hospitalizations for the entire cohort was 4.2 (range, 1-18 hospitalizations). Patients who died spent a mean of 28.3% of their life after diagnosis in the hospital and 13.8% of their life attending outpatient clinic appointments. Although the majority of patients (87.9%) died during the 2-year follow-up period, a minority received palliative care (16.2%) or hospice (23.1%) services. Within 30 days of death, 84.5% of patients were hospitalized, and 61% died in the hospital. Among the patients who died, those who received intensive induction therapy (vs nonintensive therapy) spent 30% more of their life after diagnosis in the hospital (P < .0001) and were less likely to receive hospice services (odds ratio, 0.45; P = .05).The current findings highlight the intensity of health care utilization among older patients with AML, regardless of treatment modality. Despite the poor prognosis, palliative care and hospice services are rarely used. Future work should study novel health care delivery models to optimize care throughout the course of illness and at the end of life.

Authors
El-Jawahri, AR; Abel, GA; Steensma, DP; LeBlanc, TW; Fathi, AT; Graubert, TA; DeAngelo, DJ; Wadleigh, M; Ballen, KK; Foster, JE; Attar, EC; Amrein, PC; Brunner, AM; Stone, RM; Temel, JS
MLA Citation
El-Jawahri, AR, Abel, GA, Steensma, DP, LeBlanc, TW, Fathi, AT, Graubert, TA, DeAngelo, DJ, Wadleigh, M, Ballen, KK, Foster, JE, Attar, EC, Amrein, PC, Brunner, AM, Stone, RM, and Temel, JS. "Health care utilization and end-of-life care for older patients with acute myeloid leukemia." Cancer 121.16 (August 2015): 2840-2848.
PMID
25926135
Source
epmc
Published In
Cancer
Volume
121
Issue
16
Publish Date
2015
Start Page
2840
End Page
2848
DOI
10.1002/cncr.29430

Symptom burden of haematological malignancies as death approaches in a community palliative care service: a retrospective cohort study of a consecutive case series.

Patients with haematological malignancies are less likely to use palliative care services than are patients with solid tumours. This difference might stem from differing symptom burden, care needs, disease trajectories, or a combination of these factors. We described symptom burden and physical decline over time for people with haematological malignancies compared with people with solid tumours in a consecutive case series.We included patients admitted to Silver Chain Hospice Care Service who died between Jan 1, 2011, and Dec 31, 2013, and who completed the eight-item Symptom Assessment Scale (0-10, with 0=no distress and 10=worst distress) at each clinical encounter. Physical function was assessed with the Australia-modified Karnofsky performance scale. Symptom and functional assessments were analysed at 7 days, 30 days, 60 days, and 90 days before death, by descriptive statistics.We included 4638 participants. For people with haematological malignancies (n=224), the most troublesome symptoms were fatigue (mean score 5·2, SD 2·7) and loss of appetite (2·3, SD 2·9), and both worsened significantly near death (p=0·0035 for fatigue, p=0·016 for appetite). Other symptoms were often absent, and changed little over time. Compared with patients with solid tumours (n=4414), there were no significant differences in individual or cumulative symptom scores, changes over time, or the pattern of functional decline.Community patients with haematological malignancies receiving palliative care have similar symptoms and patterns of physical decline at the end of life to people with solid tumours, suggesting similar care needs. This finding questions present limited palliative care service use by patients with haematological malignancies.None.

Authors
LeBlanc, TW; Smith, JM; Currow, DC
MLA Citation
LeBlanc, TW, Smith, JM, and Currow, DC. "Symptom burden of haematological malignancies as death approaches in a community palliative care service: a retrospective cohort study of a consecutive case series." The Lancet. Haematology 2.8 (August 2015): e334-e338.
PMID
26688486
Source
epmc
Published In
The Lancet. Haematology
Volume
2
Issue
8
Publish Date
2015
Start Page
e334
End Page
e338
DOI
10.1016/s2352-3026(15)00111-8

Cancer-Related Fatigue, Version 2.2015.

Cancer-related fatigue is defined as a distressing, persistent, subjective sense of physical, emotional, and/or cognitive tiredness or exhaustion related to cancer or cancer treatment that is not proportional to recent activity and interferes with usual functioning. It is one of the most common side effects in patients with cancer. Fatigue has been shown to be a consequence of active treatment, but it may also persist into posttreatment periods. Furthermore, difficulties in end-of-life care can be compounded by fatigue. The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Cancer-Related Fatigue provide guidance on screening for fatigue and recommendations for interventions based on the stage of treatment. Interventions may include education and counseling, general strategies for the management of fatigue, and specific nonpharmacologic and pharmacologic interventions. Fatigue is a frequently underreported complication in patients with cancer and, when reported, is responsible for reduced quality of life. Therefore, routine screening to identify fatigue is an important component in improving the quality of life for patients living with cancer.

Authors
Berger, AM; Mooney, K; Alvarez-Perez, A; Breitbart, WS; Carpenter, KM; Cella, D; Cleeland, C; Dotan, E; Eisenberger, MA; Escalante, CP; Jacobsen, PB; Jankowski, C; LeBlanc, T; Ligibel, JA; Loggers, ET; Mandrell, B; Murphy, BA; Palesh, O; Pirl, WF; Plaxe, SC; Riba, MB; Rugo, HS; Salvador, C; Wagner, LI; Wagner-Johnston, ND; Zachariah, FJ; Bergman, MA; Smith, C
MLA Citation
Berger, AM, Mooney, K, Alvarez-Perez, A, Breitbart, WS, Carpenter, KM, Cella, D, Cleeland, C, Dotan, E, Eisenberger, MA, Escalante, CP, Jacobsen, PB, Jankowski, C, LeBlanc, T, Ligibel, JA, Loggers, ET, Mandrell, B, Murphy, BA, Palesh, O, Pirl, WF, Plaxe, SC, Riba, MB, Rugo, HS, Salvador, C, Wagner, LI, Wagner-Johnston, ND, Zachariah, FJ, Bergman, MA, and Smith, C. "Cancer-Related Fatigue, Version 2.2015." Journal of the National Comprehensive Cancer Network : JNCCN 13.8 (August 2015): 1012-1039.
PMID
26285247
Source
epmc
Published In
Journal of the National Comprehensive Cancer Network : JNCCN
Volume
13
Issue
8
Publish Date
2015
Start Page
1012
End Page
1039

Polypharmacy in patients with advanced cancer and the role of medication discontinuation.

Polypharmacy is a well known problem in elderly patients in general, but its prevalence and effects in patients with cancer are less clear, particularly in end-of-life settings. This Review examines the existing literature on polypharmacy in advanced cancer and end-of-life settings by reviewing evidence-based approaches to reduce polypharmacy, and outlining the potential benefits of decreasing the number of drugs that patients with cancer can take, with emphasis on the need for thoughtful discontinuation initiatives in the context of life-limiting malignant disease. In view of the apparent burden of polypharmacy in patients with advanced cancer, we expect that greater attention to polypharmacy could lead to improvements in adverse drug events, cost, and possibly quality of life. However, few data for specific interventions in the advanced cancer population are available, and thus more research is warranted.

Authors
LeBlanc, TW; McNeil, MJ; Kamal, AH; Currow, DC; Abernethy, AP
MLA Citation
LeBlanc, TW, McNeil, MJ, Kamal, AH, Currow, DC, and Abernethy, AP. "Polypharmacy in patients with advanced cancer and the role of medication discontinuation." The Lancet. Oncology 16.7 (July 2015): e333-e341.
PMID
26149885
Source
epmc
Published In
The Lancet Oncology
Volume
16
Issue
7
Publish Date
2015
Start Page
e333
End Page
e341
DOI
10.1016/s1470-2045(15)00080-7

Safety and benefit of discontinuing statin therapy in the setting of advanced, life-limiting illness: a randomized clinical trial.

For patients with limited prognosis, some medication risks may outweigh the benefits, particularly when benefits take years to accrue; statins are one example. Data are lacking regarding the risks and benefits of discontinuing statin therapy for patients with limited life expectancy.To evaluate the safety, clinical, and cost impact of discontinuing statin medications for patients in the palliative care setting.This was a multicenter, parallel-group, unblinded, pragmatic clinical trial. Eligibility included adults with an estimated life expectancy of between 1 month and 1 year, statin therapy for 3 months or more for primary or secondary prevention of cardiovascular disease, recent deterioration in functional status, and no recent active cardiovascular disease. Participants were randomized to either discontinue or continue statin therapy and were monitored monthly for up to 1 year. The study was conducted from June 3, 2011, to May 2, 2013. All analyses were performed using an intent-to-treat approach.Statin therapy was withdrawn from eligible patients who were randomized to the discontinuation group. Patients in the continuation group continued to receive statins.Outcomes included death within 60 days (primary outcome), survival, cardiovascular events, performance status, quality of life (QOL), symptoms, number of nonstatin medications, and cost savings.A total of 381 patients were enrolled; 189 of these were randomized to discontinue statins, and 192 were randomized to continue therapy. Mean (SD) age was 74.1 (11.6) years, 22.0% of the participants were cognitively impaired, and 48.8% had cancer. The proportion of participants in the discontinuation vs continuation groups who died within 60 days was not significantly different (23.8% vs 20.3%; 90% CI, -3.5% to 10.5%; P=.36) and did not meet the noninferiority end point. Total QOL was better for the group discontinuing statin therapy (mean McGill QOL score, 7.11 vs 6.85; P=.04). Few participants experienced cardiovascular events (13 in the discontinuation group vs 11 in the continuation group). Mean cost savings were $3.37 per day and $716 per patient.This pragmatic trial suggests that stopping statin medication therapy is safe and may be associated with benefits including improved QOL, use of fewer nonstatin medications, and a corresponding reduction in medication costs. Thoughtful patient-provider discussions regarding the uncertain benefit and potential decrement in QOL associated with statin continuation in this setting are warranted.clinicaltrials.gov Identifier: NCT01415934.

Authors
Kutner, JS; Blatchford, PJ; Taylor, DH; Ritchie, CS; Bull, JH; Fairclough, DL; Hanson, LC; LeBlanc, TW; Samsa, GP; Wolf, S; Aziz, NM; Currow, DC; Ferrell, B; Wagner-Johnston, N; Zafar, SY; Cleary, JF; Dev, S; Goode, PS; Kamal, AH; Kassner, C; Kvale, EA; McCallum, JG; Ogunseitan, AB; Pantilat, SZ; Portenoy, RK; Prince-Paul, M; Sloan, JA; Swetz, KM; Von Gunten, CF; Abernethy, AP
MLA Citation
Kutner, JS, Blatchford, PJ, Taylor, DH, Ritchie, CS, Bull, JH, Fairclough, DL, Hanson, LC, LeBlanc, TW, Samsa, GP, Wolf, S, Aziz, NM, Currow, DC, Ferrell, B, Wagner-Johnston, N, Zafar, SY, Cleary, JF, Dev, S, Goode, PS, Kamal, AH, Kassner, C, Kvale, EA, McCallum, JG, Ogunseitan, AB, Pantilat, SZ, Portenoy, RK, Prince-Paul, M, Sloan, JA, Swetz, KM, Von Gunten, CF, and Abernethy, AP. "Safety and benefit of discontinuing statin therapy in the setting of advanced, life-limiting illness: a randomized clinical trial." JAMA internal medicine 175.5 (May 2015): 691-700.
PMID
25798575
Source
epmc
Published In
JAMA Internal Medicine
Volume
175
Issue
5
Publish Date
2015
Start Page
691
End Page
700
DOI
10.1001/jamainternmed.2015.0289

Correlation between the international consensus definition of the Cancer Anorexia-Cachexia Syndrome (CACS) and patient-centered outcomes in advanced non-small cell lung cancer.

The cancer anorexia-cachexia syndrome (CACS) is common in patients with advanced solid tumors and is associated with adverse outcomes including poor quality of life (QOL), impaired functioning, and shortened survival.To apply the recently posed weight-based international consensus CACS definition to a population of patients with advanced non-small cell lung cancer (NSCLC) and explore its impact on patient-reported outcomes.Ninety-nine patients participated in up to four study visits over a six-month period. Longitudinal assessments included measures of physical function, QOL, and other clinical variables such as weight and survival.Patients meeting the consensus CACS criteria at Visit 1 had a significantly shorter median survival (239.5 vs. 446 days; hazard ratio, 2.06, P < 0.05). Physical function was worse in the CACS group (mean Karnofsky Performance Status score 68 vs. 77, Eastern Cooperative Oncology Group Performance Status score 1.8 vs. 1.3, P < 0.05 for both), as was QOL (Functional Assessment of Cancer Therapy-General [FACT-G] Lung Cancer subscale of 17.2 vs. 19.9, Anorexia/Cachexia subscale of 31.4 vs. 37.9, P < 0.05 for both). Differences in the FACT-G and the Functional Assessment of Chronic Illness Therapy-Fatigue subscale approached but did not reach statistical significance. Longitudinally, all measures of physical function and QOL worsened regardless of CACS status, but the rate of decline was more rapid in the CACS group.The weight-based component of the recently proposed international consensus CACS definition is useful in identifying patients with advanced NSCLC who are likely to have significantly inferior survival and who will develop more precipitous declines in physical function and QOL. This definition may be useful for clinical screening purposes and identify patients with high palliative care needs.

Authors
LeBlanc, TW; Nipp, RD; Rushing, CN; Samsa, GP; Locke, SC; Kamal, AH; Cella, DF; Abernethy, AP
MLA Citation
LeBlanc, TW, Nipp, RD, Rushing, CN, Samsa, GP, Locke, SC, Kamal, AH, Cella, DF, and Abernethy, AP. "Correlation between the international consensus definition of the Cancer Anorexia-Cachexia Syndrome (CACS) and patient-centered outcomes in advanced non-small cell lung cancer." Journal of pain and symptom management 49.4 (April 2015): 680-689.
PMID
25461669
Source
epmc
Published In
Journal of Pain and Symptom Management
Volume
49
Issue
4
Publish Date
2015
Start Page
680
End Page
689
DOI
10.1016/j.jpainsymman.2014.09.008

What is different about patients with hematologic malignancies? A retrospective cohort study of cancer patients referred to a hospice research network.

CONTEXT: Although much is known about solid tumor patients who use hospice, the hematologic malignancies hospice population is inadequately described. OBJECTIVES: To compare the characteristics and outcomes of hospice patients with hematologic malignancies to those with solid tumors. METHODS: We extracted electronic patient data (2008-2012) from a large hospice network (Coalition of Hospices Organized to Investigate Comparative Effectiveness) and used bivariate analyses to describe between-group differences. RESULTS: In total, 48,147 patients with cancer were admitted during the study period; 3518 (7.3%) had a hematologic malignancy. These patients had significantly worse Palliative Performance Scale scores (32% vs. 24% were below 40; P < 0.001) and shorter lengths of stay (median 11 vs. 19 days; P < 0.001). They were more likely to die within 24 hours of hospice enrollment (10.9% vs. 6.8%; odds ratio [OR] 1.66; 95% CI 1.49, 1.86; P < 0.001) or within seven days (36% vs. 25.1%; OR 1.68; 95% CI 1.56, 1.81; P < 0.001) and were more likely to receive hospice services in an inpatient or nursing home setting (OR 1.34; 95% CI 1.16, 1.56 and OR 1.54; 95% CI 1.39, 1.72; both P < 0.001). Among hematologic malignancy patients, those with leukemia had the shortest survival (hazard ratio 1.23; 95% CI 1.13, 1.34; P < 0.001), and 40.3% used hospice for less than seven days (OR 1.31; 95% CI 1.11, 1.56; P = 0.002). CONCLUSION: Hospice patients with hematologic malignancies are more seriously ill at the time of admission, with worse functional status and shorter lengths of stay than other cancer patients. Differences in outcomes suggest the need for targeted interventions to optimize hospice services for the hematologic malignancies population, especially those with leukemia.

Authors
LeBlanc, TW; Abernethy, AP; Casarett, DJ
MLA Citation
LeBlanc, TW, Abernethy, AP, and Casarett, DJ. "What is different about patients with hematologic malignancies? A retrospective cohort study of cancer patients referred to a hospice research network." Journal of pain and symptom management 49.3 (March 2015): 505-512.
PMID
25116911
Source
epmc
Published In
Journal of Pain and Symptom Management
Volume
49
Issue
3
Publish Date
2015
Start Page
505
End Page
512
DOI
10.1016/j.jpainsymman.2014.07.003

Perceptions of palliative care among hematologic malignancy specialists: a mixed-methods study.

Patients with hematologic malignancies are less likely to receive specialist palliative care services than patients with solid tumors. Reasons for this difference are poorly understood.This was a multisite, mixed-methods study to understand and contrast perceptions of palliative care among hematologic and solid tumor oncologists using surveys assessing referral practices and in-depth semistructured interviews exploring views of palliative care. We compared referral patterns using standard statistical methods. We analyzed qualitative interview data using constant comparative methods to explore reasons for observed differences.Among 66 interviewees, 23 oncologists cared exclusively for patients with hematologic malignancies; 43 treated only patients with solid tumors. Seven (30%) of 23 hematologic oncologists reported never referring to palliative care; all solid tumor oncologists had previously referred. In qualitative analyses, most hematologic oncologists viewed palliative care as end-of-life care, whereas most solid tumor oncologists viewed palliative care as a subspecialty that could assist with complex patient cases. Solid tumor oncologists emphasized practical barriers to palliative care referral, such as appointment availability and reimbursement issues. Hematologic oncologists emphasized philosophic concerns about palliative care referrals, including different treatment goals, responsiveness to chemotherapy, and preference for controlling even palliative aspects of patient care.Most hematologic oncologists view palliative care as end-of-life care, whereas solid tumor oncologists more often view palliative care as a subspecialty for comanaging patients with complex cases. Efforts to integrate palliative care into hematologic malignancy practices will require solutions that address unique barriers to palliative care referral experienced by hematologic malignancy specialists.

Authors
LeBlanc, TW; O'Donnell, JD; Crowley-Matoka, M; Rabow, MW; Smith, CB; White, DB; Tiver, GA; Arnold, RM; Schenker, Y
MLA Citation
LeBlanc, TW, O'Donnell, JD, Crowley-Matoka, M, Rabow, MW, Smith, CB, White, DB, Tiver, GA, Arnold, RM, and Schenker, Y. "Perceptions of palliative care among hematologic malignancy specialists: a mixed-methods study." Journal of oncology practice 11.2 (March 2015): e230-e238.
PMID
25784580
Source
epmc
Published In
Journal of Oncology Practice
Volume
11
Issue
2
Publish Date
2015
Start Page
e230
End Page
e238
DOI
10.1200/jop.2014.001859

Communication skills training in the twenty-first century.

Authors
LeBlanc, TW
MLA Citation
LeBlanc, TW. "Communication skills training in the twenty-first century." AMA journal of ethics 17.2 (February 2015): 140-143.
PMID
25676227
Source
epmc
Published In
AMA journal of ethics
Volume
17
Issue
2
Publish Date
2015
Start Page
140
End Page
143
DOI
10.1001/virtualmentor.2015.17.02.medu2-1502

Management of cancer pain

Authors
LeBlanc, TW; Abernethy, AP
MLA Citation
LeBlanc, TW, and Abernethy, AP. "Management of cancer pain." DeVita, Hellman, and Rosenberg's Cancer: Principles & Practice of Oncology: Tenth Edition. January 7, 2015.
Source
scopus
Publish Date
2015

When and why should patients with hematologic malignancies see a palliative care specialist?

Palliative care is a multidisciplinary approach to symptom management, psychosocial support, and assistance in treatment decision-making for patients with serious illness and their families. It emphasizes well-being at any point along the disease trajectory, regardless of prognosis. The term "palliative care" is often incorrectly used as a synonym for end-of-life care, or "hospice care". However, palliative care does not require a terminal diagnosis or proximity to death, a misconception that we will address in this article. Multiple randomized clinical trials demonstrate the many benefits of early integration of palliative care for patients with cancer, including reductions in symptom burden, improvements in quality-of-life, mood, and overall survival, as well as improved caregiver outcomes. Thus, early concurrent palliative care integrated with cancer-directed care has emerged as a standard-of-care practice for patients with cancer. However, patients with hematologic malignancies rarely utilize palliative care services, despite their many unmet palliative care needs, and are much less likely to use palliative care compared to patients with solid tumors. In this article, we will define "palliative care" and address some common misconceptions regarding its role as part of high-quality care for patients with cancer. We will then review the evidence supporting the integration of palliative care into comprehensive cancer care, discuss perceived barriers to palliative care in hematologic malignancies, and suggest opportunities and triggers for earlier and more frequent palliative care referral in this population.

Authors
LeBlanc, TW; El-Jawahri, A
MLA Citation
LeBlanc, TW, and El-Jawahri, A. "When and why should patients with hematologic malignancies see a palliative care specialist?." Hematology. American Society of Hematology. Education Program 2015 (January 2015): 471-478. (Review)
PMID
26637760
Source
epmc
Published In
Hematology / the Education Program of the American Society of Hematology. American Society of Hematology. Education Program
Volume
2015
Publish Date
2015
Start Page
471
End Page
478
DOI
10.1182/asheducation-2015.1.471

Early integration of palliative care into the care of patients with cancer.

Authors
Thienprayoon, R; LeBlanc, T
MLA Citation
Thienprayoon, R, and LeBlanc, T. "Early integration of palliative care into the care of patients with cancer." Hematology Am Soc Hematol Educ Program 2015 (2015): 479-483. (Review)
PMID
26637761
Source
pubmed
Published In
Hematology / the Education Program of the American Society of Hematology. American Society of Hematology. Education Program
Volume
2015
Publish Date
2015
Start Page
479
End Page
483
DOI
10.1182/asheducation-2015.1.479

Palliative care and hematologic malignancies: old dog, new tricks?

Authors
LeBlanc, TW
MLA Citation
LeBlanc, TW. "Palliative care and hematologic malignancies: old dog, new tricks?." Journal of oncology practice 10.6 (November 2014): e404-e407.
PMID
25398962
Source
epmc
Published In
Journal of Oncology Practice
Volume
10
Issue
6
Publish Date
2014
Start Page
e404
End Page
e407
DOI
10.1200/jop.2014.000968

Electronic Health Records (EHRs) in the oncology clinic: how clinician interaction with EHRs can improve communication with the patient.

Authors
LeBlanc, TW; Back, AL; Danis, M; Abernethy, AP
MLA Citation
LeBlanc, TW, Back, AL, Danis, M, and Abernethy, AP. "Electronic Health Records (EHRs) in the oncology clinic: how clinician interaction with EHRs can improve communication with the patient." Journal of oncology practice 10.5 (September 2014): 317-321.
PMID
25027025
Source
epmc
Published In
Journal of Oncology Practice
Volume
10
Issue
5
Publish Date
2014
Start Page
317
End Page
321
DOI
10.1200/jop.2014.001385

Building the palliative care evidence base: Lessons from a randomized controlled trial of oxygen vs room air for refractory dyspnea.

Palliative care is increasingly seen as a standard component of high-quality comprehensive cancer care. However, several challenges remain to its widespread integration into clinical oncology practice, including workforce problems, reimbursement concerns, and a fledgling evidence base. This article discusses issues surrounding evidence base development in palliative cancer care, using the example of a recently published randomized controlled trial of oxygen versus room air. The Oxygen Trial randomized patients with refractory dyspnea and adequate Pao2 to oxygen or room air, administered via nasal cannula. Both groups experienced improvements in self-rated dyspnea scores, but no statistical differences were seen between intervention arms. These results suggest that supplementary oxygen is often unnecessary in the palliative setting, and that room air is similarly efficacious. This example highlights the importance and need for ongoing development of the evidence base in palliative medicine. The Palliative Care Research Cooperative (PCRC) is a novel National Institute of Nursing Research-funded research infrastructure that seeks to expand the palliative care evidence base. Its first multisite trial was recently completed, assessing the pragmatic question of whether statin medications can be safely discontinued in end-of-life settings. The PCRC will be a vehicle through which a high-quality evidence base will continue to expand and develop. Such ongoing research efforts are needed to inform and improve palliative care practice.

Authors
LeBlanc, TW; Abernethy, AP
MLA Citation
LeBlanc, TW, and Abernethy, AP. "Building the palliative care evidence base: Lessons from a randomized controlled trial of oxygen vs room air for refractory dyspnea." Journal of the National Comprehensive Cancer Network : JNCCN 12.7 (July 2014): 989-992.
PMID
24994919
Source
epmc
Published In
Journal of the National Comprehensive Cancer Network : JNCCN
Volume
12
Issue
7
Publish Date
2014
Start Page
989
End Page
992

Rituximab for follicular lymphoma: watch and wait, watch and worry, or watch and live?

Authors
LeBlanc, T; Kamal, A; Abernethy, A
MLA Citation
LeBlanc, T, Kamal, A, and Abernethy, A. "Rituximab for follicular lymphoma: watch and wait, watch and worry, or watch and live?." The Lancet. Oncology 15.7 (June 2014): e251-e252. (Letter)
PMID
24872108
Source
epmc
Published In
The Lancet Oncology
Volume
15
Issue
7
Publish Date
2014
Start Page
e251
End Page
e252
DOI
10.1016/s1470-2045(14)70215-3

Patient understanding of medical jargon: a survey study of U.S. medical students.

OBJECTIVE: With increasing exposure, medical students may forget that technical jargon is unfamiliar to laypeople. To investigate this possibility, authors assessed student perceptions of patient understanding across different years in medical school. METHODS: 533 students at 4 U.S. medical schools rated the proportion of patients likely to understand each of twenty-one different jargon terms. Students were either in the first month of their first year, the middle of their first year, or the middle of their fourth year of medical school. RESULTS: Fourth-year students were slightly more pessimistic about patients' understanding compared to new first-year students (mean percent understanding of 55.1% vs. 58.6%, p=0.004). Students both over- and under-estimated patient understanding of specific words compared to published estimates. In a multivariate model, other factors did not explain these differences. CONCLUSION: Students do not generally presume that patients understand medical jargon. In many cases they actually underestimate patients' understanding, and these estimates may become more pessimistic longitudinally. Jargon use in communication with patients does not appear to stem from unrealistic presumptions about patients' understanding or from desensitization to jargon during medical school. PRACTICE IMPLICATIONS: Training about patient knowledge of medical jargon may be a useful addition to communication skills curricula.

Authors
LeBlanc, TW; Hesson, A; Williams, A; Feudtner, C; Holmes-Rovner, M; Williamson, LD; Ubel, PA
MLA Citation
LeBlanc, TW, Hesson, A, Williams, A, Feudtner, C, Holmes-Rovner, M, Williamson, LD, and Ubel, PA. "Patient understanding of medical jargon: a survey study of U.S. medical students." Patient education and counseling 95.2 (May 2014): 238-242.
PMID
24525222
Source
epmc
Published In
Patient Education and Counseling
Volume
95
Issue
2
Publish Date
2014
Start Page
238
End Page
242
DOI
10.1016/j.pec.2014.01.014

On Goldilocks, care coordination, and palliative care: making it 'just right'.

Authors
LeBlanc, TW; Currow, DC; Abernethy, AP
MLA Citation
LeBlanc, TW, Currow, DC, and Abernethy, AP. "On Goldilocks, care coordination, and palliative care: making it 'just right'." Primary care respiratory journal : journal of the General Practice Airways Group 23.1 (March 2014): 8-10.
PMID
24553823
Source
epmc
Published In
Primary Care Respiratory Journal
Volume
23
Issue
1
Publish Date
2014
Start Page
8
End Page
10
DOI
10.4104/pcrj.2014.00017

In the sandbox: palliative care and hematologic malignancies.

Palliative care specialists have had little involvement in the care of patients with hematologic malignancies. The reasons for this are not clear, because these patients certainly face a significant symptom burden, and many hematologic malignancies are either incurable or carry poor prognoses. For example, acute myeloid leukemia (AML) in patients over age 60 has a 5-year survival of less than 10%, akin to pancreatic cancer. Although most oncologists would agree with involving palliative care specialists in the case of advanced pancreatic cancer, few seem to consider this in the context of AML. Why should AML be any different?

Authors
LeBlanc, TW
MLA Citation
LeBlanc, TW. "In the sandbox: palliative care and hematologic malignancies." J Community Support Oncol 12.2 (February 2014): 44-45.
PMID
24971402
Source
pubmed
Published In
The Journal of community and supportive oncology
Volume
12
Issue
2
Publish Date
2014
Start Page
44
End Page
45

On Goldilocks, care coordination, and palliative care: Making it 'just right'

Authors
LeBlanc, TW; Currow, DC; Abernethy, AP
MLA Citation
LeBlanc, TW, Currow, DC, and Abernethy, AP. "On Goldilocks, care coordination, and palliative care: Making it 'just right'." Primary Care Respiratory Journal 23.1 (January 1, 2014): 8-10.
Source
scopus
Published In
Primary Care Respiratory Journal
Volume
23
Issue
1
Publish Date
2014
Start Page
8
End Page
10
DOI
10.4104/pcrj.2014.00017

Patient understanding of medical jargon: A survey study of U.S. medical students

Objective: With increasing exposure, medical students may forget that technical jargon is unfamiliar to laypeople. To investigate this possibility, authors assessed student perceptions of patient understanding across different years in medical school. Methods: 533 students at 4 U.S. medical schools rated the proportion of patients likely to understand each of twenty-one different jargon terms. Students were either in the first month of their first year, the middle of their first year, or the middle of their fourth year of medical school. Results: Fourth-year students were slightly more pessimistic about patients' understanding compared to new first-year students (mean percent understanding of 55.1% vs. 58.6%, p= 0.004). Students both over- and under-estimated patient understanding of specific words compared to published estimates. In a multivariate model, other factors did not explain these differences. Conclusion: Students do not generally presume that patients understand medical jargon. In many cases they actually underestimate patients' understanding, and these estimates may become more pessimistic longitudinally. Jargon use in communication with patients does not appear to stem from unrealistic presumptions about patients' understanding or from desensitization to jargon during medical school. Practice implications: Training about patient knowledge of medical jargon may be a useful addition to communication skills curricula. © 2014 Elsevier Ireland Ltd.

Authors
LeBlanc, TW; Hesson, A; Williams, A; Feudtner, C; Holmes-Rovner, M; Williamson, LD; Ubel, PA
MLA Citation
LeBlanc, TW, Hesson, A, Williams, A, Feudtner, C, Holmes-Rovner, M, Williamson, LD, and Ubel, PA. "Patient understanding of medical jargon: A survey study of U.S. medical students." Patient Education and Counseling 95.2 (January 1, 2014): 238-242.
Source
scopus
Published In
Patient Education and Counseling
Volume
95
Issue
2
Publish Date
2014
Start Page
238
End Page
242
DOI
10.1016/j.pec.2014.01.014

Overcoming recruitment challenges in palliative care clinical trials.

PURPOSE: Palliative care is increasingly viewed as a necessary component of cancer care, especially for patients with advanced disease. Rigorous clinical trials are thus needed to build the palliative care evidence base, but clinical research-especially participant recruitment-is difficult. Major barriers include (1) patient factors, (2) "gatekeeping," and (3) ethical concerns. Here we discuss an approach to overcoming these barriers, using the Palliative Care Trial (PCT) as a case study. PATIENTS AND METHODS: The PCT was a 2 × 2 × 2 factorial randomized controlled trial (RCT) of different service delivery models to improve pain control in the palliative setting. It used a recruitment protocol that fused evidence-based strategies with principles of "social marketing," an approach involving the systematic application of marketing techniques. Main components included (1) an inclusive triage algorithm, (2) information booklets targeting particular stakeholders, (3) a specialized recruitment nurse, and (4) standardization of wording across all study communications. RESULTS: From an eligible pool of 607 patients, the PCT enrolled 461 patients over 26 months. Twenty percent of patients referred to the palliative care service were enrolled (76% of those eligible after screening). Several common barriers were minimized; among those who declined participation, family disinterest was uncommon (5%), as was the perception of burden imposed (4%). CONCLUSION: Challenges to clinical trial recruitment in palliative care are significant but not insurmountable. A carefully crafted recruitment and retention protocol can be effective. Our experience with designing and deploying a social-marketing-based protocol shows the benefits of such an approach.

Authors
LeBlanc, TW; Lodato, JE; Currow, DC; Abernethy, AP
MLA Citation
LeBlanc, TW, Lodato, JE, Currow, DC, and Abernethy, AP. "Overcoming recruitment challenges in palliative care clinical trials." J Oncol Pract 9.6 (November 2013): 277-282.
PMID
24130254
Source
pubmed
Published In
Journal of Oncology Practice
Volume
9
Issue
6
Publish Date
2013
Start Page
277
End Page
282
DOI
10.1200/JOP.2013.000996

Defining quality, disseminating evidence, and enforcing guidelines for cancer treatment.

Authors
Leblanc, TW; Abernethy, AP
MLA Citation
Leblanc, TW, and Abernethy, AP. "Defining quality, disseminating evidence, and enforcing guidelines for cancer treatment. (Published online)" Virtual Mentor 15.8 (August 1, 2013): 713-717.
PMID
23937789
Source
pubmed
Published In
The virtual mentor : VM
Volume
15
Issue
8
Publish Date
2013
Start Page
713
End Page
717
DOI
10.1001/virtualmentor.2013.15.8.oped1-1308

The message isn't as mean as we may think.

Authors
LeBlanc, TW
MLA Citation
LeBlanc, TW. "The message isn't as mean as we may think. (Published online)" Virtual Mentor 15.1 (January 1, 2013): 82-85.
PMID
23356813
Source
pubmed
Published In
The virtual mentor : VM
Volume
15
Issue
1
Publish Date
2013
Start Page
82
End Page
85
DOI
10.1001/virtualmentor.2013.15.1.mnar2-1301

The ethics of health information technology in oncology: emerging isssues from both local and global perspectives.

Health information technology (HIT) is ever-increasing in complexity and has incrementally become a fundamental part of our everyday clinical lives. As HIT becomes more complex and commonplace, so do the questions it raises about stewardship and usage of data, along with the ethics of these applications. With the development of rapid-learning systems, such as ASCO's CancerLinQ, careful thought about the ethics and applications of these technologies is necessary. This article uses the principles-based framework of modern bioethics to examine evolving ethical issues that arise in the context of HIT and also discusses HIT's application in reducing cancer care disparities in the developing world. We recognize that this topic is quite broad, so here we provide an overview of the issues, rather than any definitive conclusions about a particular "correct path." Our hope is to stimulate discussion about this important topic, which will increasingly need to be addressed in the oncology community.

Authors
LeBlanc, TW; Shulman, LN; Yu, PP; Hirsch, BR; Abernethy, AP
MLA Citation
LeBlanc, TW, Shulman, LN, Yu, PP, Hirsch, BR, and Abernethy, AP. "The ethics of health information technology in oncology: emerging isssues from both local and global perspectives." Am Soc Clin Oncol Educ Book (2013): 136-142. (Review)
PMID
23714480
Source
pubmed
Published In
American Society of Clinical Oncology educational book / ASCO. American Society of Clinical Oncology. Meeting
Publish Date
2013
Start Page
136
End Page
142
DOI
10.1200/EdBook_AM.2013.33.136

Quality of life in higher resolution: The next generation of comparative effectiveness research in malignant hematology

Authors
LeBlanc, TW; Abernethy, AP
MLA Citation
LeBlanc, TW, and Abernethy, AP. "Quality of life in higher resolution: The next generation of comparative effectiveness research in malignant hematology." Haematologica 98.6 (2013): 823-824.
PMID
23729721
Source
scival
Published In
Haematologica
Volume
98
Issue
6
Publish Date
2013
Start Page
823
End Page
824
DOI
10.3324/haematol.2013.085787

Discontinuation of statins in routine care settings

Authors
LeBlanc, TW; Kutner, JS; Ritchie, CS; Abernethy, AP
MLA Citation
LeBlanc, TW, Kutner, JS, Ritchie, CS, and Abernethy, AP. "Discontinuation of statins in routine care settings." Annals of Internal Medicine 159.1 (2013): 74-75.
PMID
23817715
Source
scival
Published In
Annals of internal medicine
Volume
159
Issue
1
Publish Date
2013
Start Page
74
End Page
75
DOI
10.7326/0003-4819-159-1-201307020-00021

Considerations in reporting palliative care clinical trials: standardizing information reported and authorship practices.

PURPOSE OF REVIEW: The nature of palliative care practice, especially the reliance on referrals and differing models of service delivery, poses unique challenges for the creation and interpretation of an evidence base, frequently limiting the applicability of data to patient care. Here we discuss two core aspects of clinical trials reporting in palliative medicine: proposed standards governing the collection and reporting of data, and rules governing authorship and publication. RECENT FINDINGS: Existing literature often inadequately describes the characteristics of patients, caregivers, clinicians, systems, and interventions included in studies, thereby limiting the utility of results. SUMMARY: A generalizability framework is needed to ensure a robust evidence base that advances practice. Lessons learned through the development of research cooperative groups in palliative care reinforce the importance of an authorship protocol for large trials and working groups.

Authors
LeBlanc, TW; Abernethy, AP; Currow, DC; Kutner, JS
MLA Citation
LeBlanc, TW, Abernethy, AP, Currow, DC, and Kutner, JS. "Considerations in reporting palliative care clinical trials: standardizing information reported and authorship practices." Curr Opin Support Palliat Care 6.4 (December 2012): 494-499. (Review)
PMID
23080306
Source
pubmed
Published In
Current Opinion in Supportive and Palliative Care
Volume
6
Issue
4
Publish Date
2012
Start Page
494
End Page
499
DOI
10.1097/SPC.0b013e3283597259

Palliative care and oncology: integration leads to better care.

Authors
LeBlanc, TW; Abernethy, AP
MLA Citation
LeBlanc, TW, and Abernethy, AP. "Palliative care and oncology: integration leads to better care." Oncology (Williston Park) 25.13 (November 30, 2011): 1275-.
PMID
22272496
Source
pubmed
Published In
Oncology
Volume
25
Issue
13
Publish Date
2011
Start Page
1275

Longitudinal patient-reported performance status assessment in the cancer clinic is feasible and prognostic.

PURPOSE: Performance status is prognostic in oncology and palliative care settings. Traditionally clinician rated, it is often inconsistently collected, recorded, and measured, thereby limiting its utility. Patient-reported strategies are increasingly used for routine symptom and quality of life assessment in the clinic, and may be useful for tracking performance status. METHODS: Tablet personal computers were used to collect patient-reported reviews of systems via the Patient Care Monitor (PCM) v2.0 for 86 patients with advanced lung cancer. Relevant subscales included the PCM Impaired Performance and Impaired Ambulation scales. Trained nurse clinicians measured performance status using traditional Karnofsky and Eastern Cooperative Oncology Group (ECOG) instruments. Correlation coefficients were used to compare performance status scales, and survival analysis was performed by Cox proportional hazards modeling. RESULTS: All four performance status scales demonstrated excellent internal consistency and convergent validity. Initial KPS and ECOG scores were statistically correlated with survival, whereas PCM scores showed a nonsignificant trend in this direction. Change in PCM Impaired Performance over time was statistically correlated with survival (hazard ratio = 1.62, P = .046), whereas the other three performance status measures were not statistically prognostic. CONCLUSION: Patient-reported performance status as measured by PCM v2.0 is at least as reliable as KPS or ECOG. The enhanced resolution provided by this patient-reported method allows for the detection of clinically meaningful changes in trajectory over time, potentially serving as an early-warning system to trigger clinical interventions. Further study is needed to test these findings on a larger scale.

Authors
Suh, S-Y; Leblanc, TW; Shelby, RA; Samsa, GP; Abernethy, AP
MLA Citation
Suh, S-Y, Leblanc, TW, Shelby, RA, Samsa, GP, and Abernethy, AP. "Longitudinal patient-reported performance status assessment in the cancer clinic is feasible and prognostic." J Oncol Pract 7.6 (November 2011): 374-381.
PMID
22379420
Source
pubmed
Published In
Journal of Oncology Practice
Volume
7
Issue
6
Publish Date
2011
Start Page
374
End Page
381
DOI
10.1200/JOP.2011.000434

Linking palliative care and oncology practice: performance status as a common thread.

Authors
Leblanc, TW; Back, AL
MLA Citation
Leblanc, TW, and Back, AL. "Linking palliative care and oncology practice: performance status as a common thread." J Oncol Pract 7.6 (November 2011): 381-382.
PMID
22379421
Source
pubmed
Published In
Journal of Oncology Practice
Volume
7
Issue
6
Publish Date
2011
Start Page
381
End Page
382
DOI
10.1200/JOP.2011.000462

Autopsy and Grief: A Case of Transformative Postmortem Examination.

Abstract Background: A physician's obligations to deliver compassionate care do not end with a patient's death. When a patient dies there remains a responsibility to assist grieving family members. Unfortunately, many physicians feel ill prepared to assist in the bereavement process, not knowing what to say or how to say it. Although underutilized, the medical autopsy can play an important role in families' grief processes, particularly in those cases wherein uncertainties exist regarding the ultimate cause of death. Discussion: Here we postulate a role for the medical autopsy in assisting families through the grief process, which we demonstrate via an illustrative case. Effective communication of these results to family members is the key to its therapeutic effect.

Authors
Leblanc, TW; Tulsky, JA; Simel, DL
MLA Citation
Leblanc, TW, Tulsky, JA, and Simel, DL. "Autopsy and Grief: A Case of Transformative Postmortem Examination." Journal of palliative medicine (August 2011). (Academic Article)
PMID
21815752
Source
manual
Published In
Journal of Palliative Medicine
Publish Date
2011
DOI
10.1089/jpm.2011.0044

What is the role of friends when contributing care at the end of life? Findings from an Australian population study.

PURPOSE: To examine the role of friends as caregivers of people with terminal illness. METHOD: Piloted questions were included in the 2001-2007 random face-to-face annual health surveys of 23588 South Australians on the death of a loved one, caregiving provided, and characteristics of the caregiver and deceased individual. The survey was representative of the population by age, gender, and region of residence. Analyses focused on friends of the deceased loved one, providing daily or intermittent 'hands on' care. Logistic regression assessed predictors of home death. RESULTS: Daily 'hands on' carers were much more likely to be female and aged between 55 and 64; there was also a younger (12 months. Home deaths were more frequent (32%, p=0.014) when friends were carers, and the rate of palliative care use was higher than when family/others provided care (70 vs 61%). Regression analyses confirmed friends as caregivers as a predictor of home death (OR 1.73: 95%, CI 1.15-2.87). CONCLUSION: Friends contribute their caregiving: A cohort of younger caregivers may reflect changing social mores as the extended family shrinks and people turn to friendship networks for care and support at the end of life.

Authors
Burns, CM; Abernethy, AP; Leblanc, TW; Currow, DC
MLA Citation
Burns, CM, Abernethy, AP, Leblanc, TW, and Currow, DC. "What is the role of friends when contributing care at the end of life? Findings from an Australian population study." Psychooncology 20.2 (February 2011): 203-212.
PMID
20238373
Source
pubmed
Published In
Psycho-Oncology
Volume
20
Issue
2
Publish Date
2011
Start Page
203
End Page
212
DOI
10.1002/pon.1725

The need for community-based palliative care for patients living with cancer

Authors
LeBlanc, TW; Abernethy, AP
MLA Citation
LeBlanc, TW, and Abernethy, AP. "The need for community-based palliative care for patients living with cancer." Oncology 25.13 (2011).
Source
scival
Published In
Oncology
Volume
25
Issue
13
Publish Date
2011

Young caregivers in the end-of-life setting: a population-based profile of an emerging group.

PURPOSE: Little is known about young caregivers of people with advanced life-limiting illness. Better understanding of the needs and characteristics of these young caregivers can inform development of palliative care and other support services. METHODS: A population-based analysis of caregivers was performed from piloted questions included in the 2001-2007 face-to-face annual health surveys of 23,706 South Australians on the death of a loved one, caregiving provided, and characteristics of the deceased individual and caregiver. The survey was representative of the population by age, gender, and region of residence. FINDINGS: Most active care was provided by older, close family members, but large numbers of young people (ages 15-29) also provided assistance to individuals with advanced life-limiting illness. They comprised 14.4% of those undertaking "hands-on" care on a daily or intermittent basis, whom we grouped together as active caregivers. Almost as many young males as females participate in active caregiving (men represent 46%); most provide care while being employed, including 38% who work full-time. Over half of those engaged in hands-on care indicated the experience to be worse or much worse than expected, with young people more frequently reporting dissatisfaction thereof. Young caregivers also exhibited an increased perception of the need for assistance with grief. CONCLUSION: Young people can be integral to end-of-life care, and represent a significant cohort of active caregivers with unique needs and experiences. They may have a more negative experience as caregivers, and increased needs for grief counseling services compared to other age cohorts of caregivers.

Authors
Burns, CM; LeBlanc, TW; Abernethy, A; Currow, D
MLA Citation
Burns, CM, LeBlanc, TW, Abernethy, A, and Currow, D. "Young caregivers in the end-of-life setting: a population-based profile of an emerging group." J Palliat Med 13.10 (October 2010): 1225-1235.
Website
http://hdl.handle.net/10161/3367
PMID
20858060
Source
pubmed
Published In
Journal of Palliative Medicine
Volume
13
Issue
10
Publish Date
2010
Start Page
1225
End Page
1235
DOI
10.1089/jpm.2010.0004

Research in end-of-life settings: an ethical inquiry.

A fundamental tension surrounds the ethics of conducting research in vulnerable populations, and specifically, research involving patients at or near the end-of-life. In Palliative Medicine, these patients' care has historically been based on compassion, clinical judgment and experience, and anecdote rather than on data generated through high-quality clinical trials. A robust evidence base to support clinical practice in the end-of-life setting is lacking. Multiple ethical objections to the conduct of research at the end of life have impeded efforts to build such an evidence base. Arguments can be categorized into claims that the goals of research conflict with the goals of care; research unduly burdens vulnerable patients and families/caregivers; genuine equipoise does not exist; and research in the palliative care setting is too difficult. The authors explore and respond to these objections, noting the vital importance of research at this stage of the illness trajectory. The authors conclude that barriers to palliative care research are surmountable, and, indeed, that the "research imperative" and principles laid out in the Belmont Report of 1979 require us to rigorously study clinical interventions used for palliative care patients-so as to provide optimal safety and outcomes for present and future patients.

Authors
LeBlanc, TW; Wheeler, JL; Abernethy, AP
MLA Citation
LeBlanc, TW, Wheeler, JL, and Abernethy, AP. "Research in end-of-life settings: an ethical inquiry." J Pain Palliat Care Pharmacother 24.3 (September 2010): 244-250. (Review)
PMID
20718645
Source
pubmed
Published In
Journal of Pain & Palliative Care Pharmacotherapy (Haworth)
Volume
24
Issue
3
Publish Date
2010
Start Page
244
End Page
250
DOI
10.3109/15360288.2010.493579

A comparative resident site visit project: a novel approach for implementing programmatic change in the duty hours era.

The Duke University Medical Center Internal Medicine Residency Program did not reach its anticipated quota of applicants during the 2008 National Residency Matching Program. Post-Match feedback regarding workload prompted an effort to redesign the general medicine service. As part of that effort, Duke program leaders sought to learn how peer programs accommodated Accreditation Council for Graduate Medical Education (ACGME) regulations. They launched the Resident Site Visit Project (RSVP).In 2008, Duke resident teams visited six other academic internal medicine residency programs based in university hospitals in the eastern United States. They conducted a systematic survey using a standardized questionnaire, interviewed program leaders and residents, and observed workflow directly. The RSVP identified strategies for accommodating ACGME rules in service design and also highlighted challenges shared by all of the programs.Discussion of the shared challenges yielded six core principles that directly guided Duke's general medicine service redesign: emphasize patient safety, reduce resident work compression, create educational opportunities, ensure automatic duty hours compliance, preserve essential program attributes, and involve stakeholders in the process of change.The Duke RSVP is an approach to programmatic change that applies information collected during site visits in defining core principles for program redesign. Collaboration between programs through resident site visits facilitates innovation, creates a foundation for change that increases stakeholder involvement, and generates opportunities for multicenter research.

Authors
Crowley, MJ; Barkauskas, CE; Srygley, FD; Kransdorf, EP; LeBlanc, TW; Simel, DL; McNeill, DB
MLA Citation
Crowley, MJ, Barkauskas, CE, Srygley, FD, Kransdorf, EP, LeBlanc, TW, Simel, DL, and McNeill, DB. "A comparative resident site visit project: a novel approach for implementing programmatic change in the duty hours era." Acad Med 85.7 (July 2010): 1140-1146.
PMID
20592509
Source
pubmed
Published In
Academic Medicine
Volume
85
Issue
7
Publish Date
2010
Start Page
1140
End Page
1146
DOI
10.1097/ACM.0b013e3181e18cee

Acute eosinophilic pneumonia secondary to daptomycin: a report of three cases.

We describe 3 cases of daptomycin-induced pulmonary toxic effects that are consistent with drug-induced acute eosinophilic pneumonia. Patients presented similarly with dyspnea, cough, hypoxia, and diffuse ground-glass opacities at chest computed tomography. Clinical suspicion for this adverse drug event and cessation of daptomycin until definitive diagnosis can be made is crucial.

Authors
Miller, BA; Gray, A; Leblanc, TW; Sexton, DJ; Martin, AR; Slama, TG
MLA Citation
Miller, BA, Gray, A, Leblanc, TW, Sexton, DJ, Martin, AR, and Slama, TG. "Acute eosinophilic pneumonia secondary to daptomycin: a report of three cases." Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 50.11 (June 2010): e63-e68. (Academic Article)
Website
http://hdl.handle.net/10161/4150
PMID
20420515
Source
manual
Published In
Clinical Infectious Diseases
Volume
50
Issue
11
Publish Date
2010
Start Page
e63
End Page
e68
DOI
10.1086/652656

Grief, interrupted.

Authors
LeBlanc, TW
MLA Citation
LeBlanc, TW. "Grief, interrupted." J Palliat Med 13.4 (April 2010): 469-470.
PMID
20384508
Source
pubmed
Published In
Journal of Palliative Medicine
Volume
13
Issue
4
Publish Date
2010
Start Page
469
End Page
470
DOI
10.1089/jpm.2009.0348

Developing the evidence base for palliative care: formation of the Palliative Care Research Cooperative and its first trial.

The field of palliative care and hospice has gained accreditation, with a growing cadre of specialists being trained, but there is a dearth of robust research evidence to guide clinical practice. After 2 years of planning, a group of senior investigators convened in January 2010 to explore the possibility of forming a research cooperative group dedicated to advancing the evidence base in palliative care and hospice. The meeting launched the Palliative Care Research Cooperative (PCRC) with an initial national/international membership, and a plan for developing policies and procedures. Proof of the concept for the PCRC is being established through the design, conduct, and dissemination of a multi-site clinical trial targeting a consensually selected, clinically relevant research question: Should patients who are taking statins for primary or secondary prevention, and who have a prognosis of < 6 months, discontinue these medications? A core group of PCRC members have developed the flagship study for the PCRC, evaluating the discontinuation of statin medications in the palliative care setting. Using the proposed trial as a case study, we underscore several approaches to overcoming common research challenges in end-of-life settings, including: 1) study design, to ensure feasibility and timeliness; 2) strategies to overcome barriers to research in this population; 3) data collection and management, to reduce the burden on patients, caregivers, research personnel, and sites while maximizing quality and efficiency; and 4) agenda setting. This article describes the rationale for convening the PCRC and highlights core principles for developing the evidence base in palliative medicine.

Authors
LeBlanc, TW; Kutner, JS; Ko, D; Wheeler, JL; Bull, J; Abernethy, AP
MLA Citation
LeBlanc, TW, Kutner, JS, Ko, D, Wheeler, JL, Bull, J, and Abernethy, AP. "Developing the evidence base for palliative care: formation of the Palliative Care Research Cooperative and its first trial." Hosp Pract (1995) 38.3 (2010): 137-143.
PMID
20890063
Source
pubmed
Published In
Hospital practice (1995)
Volume
38
Issue
3
Publish Date
2010
Start Page
137
End Page
143
DOI
10.3810/hp.2010.06.320

Primary care--lifelines and shortages.

Authors
LeBlanc, TW
MLA Citation
LeBlanc, TW. "Primary care--lifelines and shortages." N Engl J Med 361.14 (October 1, 2009): 1414-. (Letter)
PMID
19802922
Source
pubmed
Published In
The New England journal of medicine
Volume
361
Issue
14
Publish Date
2009
Start Page
1414

Is there a duty to inform patients of phase I trials?

Authors
Bruce, CR; Flamm, AL; Leblanc, TW; Rosoff, PM
MLA Citation
Bruce, CR, Flamm, AL, Leblanc, TW, and Rosoff, PM. "Is there a duty to inform patients of phase I trials? (Published online)." Virtual Mentor 11.3 (March 1, 2009): 207-214.
PMID
23194901
Source
pubmed
Published In
Virtual Mentor
Volume
11
Issue
3
Publish Date
2009
Start Page
207
End Page
214
DOI
10.1001/virtualmentor.2009.11.3.ccas2-0903

Early evidence of unprofessional behavior found in medical student records.

Authors
Leblanc, T
MLA Citation
Leblanc, T. "Early evidence of unprofessional behavior found in medical student records. (Published online)" Virtual Mentor 9.4 (April 1, 2007): 290-294.
PMID
23217972
Source
pubmed
Published In
Virtual Mentor
Volume
9
Issue
4
Publish Date
2007
Start Page
290
End Page
294
DOI
10.1001/virtualmentor.2007.9.4.jdsc1-0704

Compassionate care at the end of life.

Authors
Leblanc, T
MLA Citation
Leblanc, T. "Compassionate care at the end of life. (Published online)" Virtual Mentor 8.9 (September 1, 2006): 557-558.
PMID
23234703
Source
pubmed
Published In
Virtual Mentor
Volume
8
Issue
9
Publish Date
2006
Start Page
557
End Page
558
DOI
10.1001/virtualmentor.2006.8.9.fred1-0609

CPR: Is It Always an Appropriate Option?

Authors
Leblanc, T
MLA Citation
Leblanc, T. "CPR: Is It Always an Appropriate Option? (Published online)." Virtual Mentor 8.9 (September 1, 2006): 586-589.
PMID
23234709
Source
pubmed
Published In
Virtual Mentor
Volume
8
Issue
9
Publish Date
2006
Start Page
586
End Page
589
DOI
10.1001/virtualmentor.2006.8.9.jdsc1-0609
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Research Areas:

  • Aged
  • Attitude of Health Personnel
  • Attitude to Death
  • Attitude to Health
  • Cardiovascular Diseases
  • Clinical Competence
  • Clinical Trials as Topic
  • Cognition Disorders
  • Communication
  • Comparative Effectiveness Research
  • Decision Making
  • Diffusion of Innovation
  • Dyspnea
  • Ethics
  • Evidence-Based Medicine
  • Guideline Adherence
  • Health Services Research
  • Hematologic Neoplasms
  • Hospice Care
  • Information Dissemination
  • Inpatients
  • Jargon
  • Leukemia
  • Lung Neoplasms
  • Lymphoma
  • Medical education
  • Myelodysplastic Syndromes
  • Myeloproliferative Disorders
  • Neoplasms
  • Nonverbal Communication
  • Odds Ratio
  • Oncology Service, Hospital
  • Outcome Assessment (Health Care)
  • Oxygen
  • Pain
  • Pain Management
  • Palliative Care
  • Patient Selection
  • Patient-Centered Care
  • Perception
  • Prognosis
  • Quality of Health Care
  • Statistics as Topic
  • Terminal Care
  • Treatment Outcome
  • Withholding Treatment