Factors Affecting Communication Patterns between Oncology Staff and Family Members of Deceased Patients: A Cross-Sectional Study

<div><p>Objective</p><p>Perceptions of the role of oncology medical staff in supporting bereaved families have evolved with the transition to interdisciplinary cancer care. We investigated the interactions between oncology professionals and bereaved families.</p><p>Methods</p><p>This cross-sectional study involved all oncology medical staff at the Davidoff Center. Participants were given a questionnaire relating to bereavement follow-up. Responses were measured using a 5-point Likert scale.</p><p>Results</p><p>Of 155 staff members, 107 filled questionnaires with <20% missing data and were included in the analysis (α = 0.799; corrected, α = 0.821). Respondents included physicians (35%), nurses (46%), social workers (7%), psychologists (4%), or unspecified (8%); 85% were Jewish, and 60% had ≥10 years of oncology experience. Most respondents thought that contacting bereaved families was important (73%), and that it provided closure for staff (79%); 41% indicated that they contacted >50% of the families of their deceased patients. Contacting bereaved families was considered the responsibility of the physicians (90%), nurses (84%), or social workers (89%). The main barriers to contacting bereaved families were emotional overload (68%) and lack of time (63%); 60% indicated a need for additional communication tools for bereavement follow-up. In a multivariate analysis, profession (physician vs. nurse), primary workplace (outpatient setting vs. other), and self-defined religion were significant variables with respect to the perceived importance of contacting bereaved families and to actually contacting them. Other factors (e.g., age, gender) were non-significant.</p><p>Conclusions</p><p>Perspectives regarding bereavement actions differ significantly across medical professions, work settings, and self-defined religions. Additional guidance and education regarding bereavement actions is warranted.</p></div

Responses of nurses by work setting (n = 49).

<p>Responses of nurses by work setting (n = 49).</p

Responses by position and work setting (n = 107).

<p>Responses by position and work setting (n = 107).</p

Participant's characteristics (n = 107).

<p>Participant's characteristics (n = 107).</p

Low molecular weight heparin (LMWH) for primary thrombo-prophylaxis in patients with solid malignancies – systematic review and meta-analysis

<div><p></p><p><b>Background.</b> Patients receiving chemotherapy for cancer are at increased risk for venous thromboembolism (VTE). We performed a meta-analysis of all randomized controlled trials (RCTs) which evaluated low molecular weight heparin (LMWH) as primary prophylaxis in ambulatory patients with solid malignancies.</p><p><b>Methods.</b> A comprehensive search was conducted until October 2013. Primary outcome was symptomatic VTE. Secondary outcomes were pulmonary embolism (PE), any VTE, deep vein thrombosis (DVT), mortality and adverse events.</p><p><b>Results.</b> Eleven trials met the inclusion criteria, and evaluated a total of 6942 patients. Primary prophylaxis with LMWH reduced symptomatic VTE (RR 0.46, 95% CI 0.32–0.67) and the rate of PE (RR 0.49, 95% CI 0.29–0.84). In the subgroup analysis of VTE in patients with lung and pancreatic cancers LMWH further reduced VTE [RR 0.42 (95% CI 0.25–0.71); RR 0.31 (95% CI 0.18–0.55), respectively]. Meta-analysis of six trials which reported survival outcomes revealed no statistically significant benefit for LMWH in one-year mortality rates (RR 0.93, 95% CI 0.83–1.04). There was no significant increase in major bleeding events (RR 1.28, 95% CI 0.84–1.95).</p><p><b>Conclusions.</b> LMWH reduces the incidence of symptomatic VTE and PE in patients receiving chemotherapy for cancer, with no apparent increase in major bleeding. The benefit is most apparent in pancreatic cancer and also lung cancer. VTE prophylaxis should be considered for these specific populations.</p></div

Bisphosphonates in the Adjuvant Setting of Breast Cancer Therapy—Effect on Survival: A Systematic Review and Meta-Analysis

<div><p>Background</p><p>The role of bisphosphonates (BP) in early breast cancer (BC) has been considered controversial. We performed a meta-analysis of all randomized controlled trials (RCTs) that appraised the effects of BP on survival in early BC.</p><p>Methods</p><p>RCTs were identified by searching the Cochrane Library, MEDLINE databases and conference proceedings. Hazard ratios (HRs) of overall survival (OS), disease-free survival (DFS) and relative risks of adverse events were estimated and pooled.</p><p>Results</p><p>Thirteen trials met the inclusion criteria, evaluating a total of 15,762 patients. Meta-analysis of ten trials which reported OS revealed no statistically significant benefit in OS for BP (HR 0.89, 95% CI = 0.79 to 1.01). Meta-analysis of nine trials which reported the DFS revealed no benefit in DFS (HR 0.95 (0.81–1.12)). Meta-analysis upon menopausal status showed a statistically significant better DFS in the BP-treated patients (HR 0.81(0.69–0.95)). In meta-regression, chemotherapy was negatively associated with HR of survival.</p><p>Conclusions</p><p>Our meta-analysis indicates a positive effect for adjuvant BP on survival only in postmenopausal patients. Meta-regression demonstrated a negative association between chemotherapy use BP effect on survival. Further large scale RCTs are warranted to unravel the specific subgroups that would benefit from the addition of BP in the adjuvant setting.</p></div

Randomized controlled trials search and selection.

<p>Randomized controlled trials search and selection.</p

Relative risks (RRs) of grade 3–4 adverse events for patients who received BP in addition to standard therapy <i>vs</i> those who received standard therapy only.

<p>Relative risks (RRs) of grade 3–4 adverse events for patients who received BP in addition to standard therapy <i>vs</i> those who received standard therapy only.</p

Forest plot of hazard ratios (HRs) comparing (A) overall survival or (B) disease-free survial (DFS) for patients who received BP in addition to standard therapy vs. those who received standard therapy only.

<p>Hazard ratios for each trail are represented by the <b>squares</b>, the size of the square represents the weight of the trial in the meta-analysis, and the <b>horizontal line</b> crossing the square represents the 95% confidence interval (CI). The <b>diamonds</b> represent the estimated overall effect based on the meta-analysis random effect of all trials.</p

Meta regression of hazard ratios of overall survival in individual studies assessing the effect of percentage of patients receiving chemotherapy in addition to endocrine therapy.

<p>Meta regression of hazard ratios of overall survival in individual studies assessing the effect of percentage of patients receiving chemotherapy in addition to endocrine therapy.</p