Publications by authors named "Andrea C Enzinger"
Purpose: Cancer-related pain is prevalent among people with advanced cancer. To improve accessibility and engagement with pain-cognitive behavioral therapy (pain-CBT), we developed and tested a serious game hosted within a mobile health intervention that delivers pain-CBT and pharmacologic support. The game focuses on teaching and practicing cognitive restructuring (CR), a central pain-CBT intervention component.
View Article and Find Full Text PDFBackground: Peritoneal carcinomatosis (PC) is common in patients with advanced gynecologic and gastrointestinal cancers. Frequently, patients with PC undergo palliative surgery or procedures to manage disease-related complications and side effects. However, there are limited data regarding patients' and family caregivers' decision-making processes about these procedures.
View Article and Find Full Text PDFObjective: Patients with advanced gynecologic (GYN) and gastrointestinal (GI) cancers frequently develop peritoneal carcinomatosis (PC), which limits prognosis and diminishes health-related quality of life (HRQoL). Palliative procedures may improve PC symptoms, yet patients and caregivers report feeling unprepared to manage ostomies, catheters, and other complex needs. Our objectives were to (1) assess the feasibility of an efficacy trial of a nurse-led telehealth intervention (BOLSTER) for patients with PC and their caregivers; and (2) assess BOLSTER's acceptability, potential to improve patients' HRQoL and self-efficacy, and potential impact on advance care planning (ACP).
View Article and Find Full Text PDFArticle Synopsis
- - The study evaluated the impact of changing the reporting recall period for electronic patient-reported outcomes (eSyM) from 7 days to 24 hours on symptom reporting in cancer patients.
- - Analyzing data from 1692 patients over 16 weeks, researchers found that a shorter recall period led to significantly lower odds of patients reporting severe and moderate symptoms, particularly in surgery patients.
- - The conclusion suggests that the ideal recall period for symptom reporting may need to be tailored depending on the purpose, whether it’s for managing symptoms, clinical trials, or other uses.
Objective: Pain is common among people with advanced cancer. While opioids provide significant relief, incorporating psycho-behavioral treatments may improve pain outcomes. We examined patients' experiences with pain self-management and how their self-management of chronic, cancer-related pain may be complemented by behavioral mobile health (mHealth) interventions.
View Article and Find Full Text PDFDevelopment and pre-pilot testing of STAMP + CBT: an mHealth app combining pain cognitive behavioral therapy and opioid support for patients with advanced cancer and pain.
Support Care Cancer
January 2024
Purpose: We developed and piloted a mobile health app to deliver cognitive behavioral therapy for pain (pain-CBT), remote symptom monitoring, and pharmacologic support for patients with pain from advanced cancer.
Methods: Using an iterative process of patient review and feedback, we developed the STAMP + CBT app. The app delivers brief daily lessons from pain-CBT and pain psychoeducation, adapted for advanced cancer.
Background: Patients with peritoneal carcinomatosis (PC) frequently undergo palliative procedures, yet these patients and their caregivers report being unprepared to manage ostomies, drains, and other complex care needs at home. The purpose of this study was to characterize the unique needs of these patients and their caregivers during care transitions.
Methods: Patients completed measures of health status and advance care planning, caregivers completed measures of preparedness and burden, and all participants completed measures of depression and anxiety.
Pain is common and variable in its severity among hospitalized patients with cancer. Although biopsychosocial factors are well established as modulators of chronic pain, less is known about what patient-level factors are associated with worse pain outcomes among hospitalized cancer patients. This prospective cohort study included patients with active cancer presenting to the emergency department (ED) with pain severity of ≥4/10 and followed pain outcomes longitudinally throughout hospital admission.
View Article and Find Full Text PDFThis study aims to adapt a video-based, multimedia chemotherapy educational intervention to meet the needs of US Latinos with advanced gastrointestinal malignancies. A five-step hybrid adaptation process involved (1) creating a multidisciplinary team with diverse Latino subject experts, (2) appraising the parent intervention, (3) identifying key cultural considerations from a systematic literature review and semi-structured Latino patient/caregiver interviews, (4) revising the intervention, highlighting culturally relevant themes through video interviews with Latino cancer patients, and (5) target population review with responsive revisions. We developed a suite of videos, booklets, and websites available in English and Spanish, which convey the risks and benefits of common chemotherapy regimens.
View Article and Find Full Text PDFWhile BRAF inhibitor combinations with EGFR and/or MEK inhibitors have improved clinical efficacy in BRAF colorectal cancer (CRC), response rates remain low and lack durability. Preclinical data suggest that BRAF/MAPK pathway inhibition may augment the tumor immune response. We performed a proof-of-concept single-arm phase 2 clinical trial of combined PD-1, BRAF and MEK inhibition with sparatlizumab (PDR001), dabrafenib and trametinib in 37 patients with BRAF CRC.
View Article and Find Full Text PDFPurpose: With the growing number of available targeted therapeutics and molecular biomarkers, the optimal care of patients with cancer now depends on a comprehensive understanding of the rapidly evolving landscape of precision oncology, which can be challenging for oncologists to navigate alone.
Methods: We developed and implemented a precision oncology decision support system, GI TARGET, (Gastrointestinal Treatment Assistance Regarding Genomic Evaluation of Tumors) within the Gastrointestinal Cancer Center at the Dana-Farber Cancer Institute. With a multidisciplinary team, we systematically reviewed tumor molecular profiling for GI tumors and provided molecularly informed clinical recommendations, which included identifying appropriate clinical trials aided by the computational matching platform MatchMiner, suggesting targeted therapy options on or off the US Food and Drug Administration-approved label, and consideration of additional or orthogonal molecular testing.
Article Synopsis
- The study aimed to investigate racial and ethnic disparities in opioid access and urine drug screening (UDS) among elderly cancer patients dying from poor-prognosis cancers between 2007 and 2019.
- It found that White, Black, and Hispanic patients all experienced decreased access to opioids at the end of life, with Black and Hispanic patients receiving notably less than their White counterparts.
- Despite considering socioeconomic factors, significant disparities in opioid access and screening persisted, particularly affecting Black men in the study population.
Article Synopsis
- - The study focused on the effectiveness of Ziv-aflibercept, a drug that inhibits vascular endothelial growth factor (VEGF), in patients with advanced neuroendocrine tumors (NETs).
- - In a phase II trial with 19 patients, the results showed a median progression-free survival of 11.8 months and a median overall survival of 36.4 months, but high rates of hypertension (95%) were observed.
- - The findings suggest that while Ziv-aflibercept has similar efficacy to other VEGF inhibitors in treating NETs, its significant side effects may limit further research on its use.
Article Synopsis
- Family caregivers play a crucial role in communicating about prognosis and end-of-life (EOL) care for patients with advanced cancer, but research on their experiences is limited.
- Interviews with 19 bereaved caregivers highlighted their struggles with communication, including information gathering, advocacy, and coordination among care teams, especially regarding challenging topics like prognosis and EOL discussions.
- These communication challenges can negatively affect caregivers' ability to support patients, leading to impacts on decision-making, care satisfaction, and their own grief experiences, underscoring the need for more research and targeted interventions.
Purpose: Black and Hispanic cancer patients experience many worse care quality and health outcomes than non-Hispanic White patients, yet less is known about disparities in caregiving responsibilities and burden among cancer caregivers.
Methods: We analyzed cross-sectional data from Cancer Care Outcomes Research and Surveillance consortium, a large multi-regional, population-based study of colorectal and lung cancer patients and their caregivers. Bivariate and multivariable regression models assessed differences by racial and ethnic groups in caregiving responsibilities and social/emotional, financial, and health burdens.
Article Synopsis
- The study aimed to develop and validate a deep learning model to extract symptoms from clinical notes in electronic health records, which are important for cancer research and monitoring.
- A total of 1,225 outpatient progress notes were analyzed, with 1,125 used for training the model and 100 for testing its accuracy, focusing on detecting 80 symptoms recognized by the National Cancer Institute.
- The best-performing model, called ELECTRA-small, achieved a high accuracy in identifying symptoms, suggesting that deep learning can effectively support system-wide tracking of symptoms in cancer care.
Article Synopsis
- Peritoneal carcinomatosis (PC) affects women with advanced gynecologic cancers, often leading to the use of ostomies, gastric tubes, or catheters, which patients and caregivers find challenging to manage.
- The study aimed to create and test the BOLSTER intervention, a support system designed for patients and caregivers post-hospitalization, which included educational content and a smartphone app to monitor symptoms.
- Initial tests showed BOLSTER to be feasible and acceptable, with a high consent rate in the second prepilot, although some participants withdrew due to feeling overwhelmed; ultimately, most who participated recommended the intervention.
Purpose: Heightened regulations have decreased opioid prescribing across the United States, yet little is known about trends in opioid access among patients dying of cancer.
Methods: Among 270,632 Medicare fee-for-service decedents with poor prognosis cancers, we used part D data to examine trends from 2007 to 2017 in opioid prescription fills and opioid potency (morphine milligram equivalents per day [MMED]) near the end-of-life (EOL), defined as the 30 days before death or hospice enrollment. We used administrative claims to evaluate trends in pain-related emergency department (ED) visits near EOL.
Article Synopsis
- Chronic cancer pain is influenced by psychosocial factors such as depression, sleep issues, and pain catastrophizing, which can affect pain severity and how it interferes with daily life.
- A study of 700 patients at a pain clinic found that older age and being African American were linked to increased pain, while lower emotional support correlated with greater pain interference.
- The research suggests that targeting psychological aspects, especially sleep problems, in treatment could help manage pain and reduce opioid use in cancer patients.
Background: The US opioid epidemic has prompted dramatic changes in public attitudes and regulations governing opioid prescribing. Little is known about the experiences of patients with advanced cancer using opioids in the context of the epidemic.
Methods: Semistructured interviews of 26 patients with advanced cancer were conducted between May 2019 and April 2020; their experiences self-managing chronic pain with opioids were evaluated.
Purpose: Patient education is critical for management of advanced cancer pain, yet the benefits of psychoeducational interventions have been modest. We used mobile health (mHealth) technology to better meet patients' needs.
Methods: Using the Agile and mHealth Development and Evaluation Frameworks, a multidisciplinary team of clinicians, researchers, patients, and design specialists followed a four-phase iterative process to develop comprehensive, tailored, multimedia cancer pain education for a patient-facing smartphone application.
Article Synopsis
- The study highlights a distress screening program implemented in a Veterans Affairs oncology clinic serving a majority African American male population with low socioeconomic status, addressing the need for better support in cancer care.
- The program, funded by the Coleman Foundation, followed a phased approach that included organizing stakeholders, educating staff, and delivering distress screenings using validated tools, but ultimately did not reach all veterans.
- Results showed that while the program engaged many patients in psychosocial services, the success varied and emphasized the need for tailored screening initiatives that consider the unique challenges faced by underserved communities, such as access to housing and food support.
Context: Many advanced patients with cancer have unrealistic prognostic expectations.
Objectives: We tested whether offering life expectancy (LE) statistics within palliative chemotherapy (PC) education promotes realistic expectations.
Methods: In this multicenter trial, patients with advanced colorectal and pancreatic cancers initiating first or second line PC were randomized to usual care versus a PC educational tool with optional LE information.