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Impaired Decision-Making Capacity in a Patient With Oral Squamous Cell Carcinoma: Weighing the Benefits and Harms of Treatment Against Objection

Jang, Charley; Seecof, Olivia M; Georgia, Annette
Impairment of medical decision-making capacity is common in acutely ill patients especially those with solid malignancies. Many of these patients lack advance directives and healthcare proxies leaving clinicians with unclear guidance on subsequent treatment decisions and few existing mechanisms to address this issue. We present a case of a 55-year-old man with recurrent oral squamous cell carcinoma who lacked decision-making capacity due to cognitive impairment. He did not have an advance directive or documented healthcare proxy. He declined curative-intent cancer-directed therapy. The dilemma of treatment over objection was carefully explored and the patient ultimately underwent palliative radiation therapy. We advocate for a multidisciplinary framework in which all potential interventions both curative and palliative including treatment over objection are thoughtfully and carefully explored. We illustrate the need for improved guidance and approaches to ensure that these patients who lack decision-making capacity have access to potentially life-saving and therapeutic interventions.
PMID: 40458845
ISSN: 2369-5293
CID: 5862232

Psilocybin-assisted psychotherapy for existential distress: practical considerations for therapeutic application-a review

Kim, Arum; Halton, Barley; Shah, Akash; Seecof, Olivia M; Ross, Stephen
Existential distress is commonly experienced by patients diagnosed with a life-threatening illness. This condition has been shown to adversely impact quality of life and is correlated with increased suicidal ideation and requests for hastened death. While palliative care teams are experienced in treating depression and anxiety, existential distress is a distinct clinical condition for which traditional medications and psychotherapy approaches demonstrate limited efficacy or duration of effect. Psychedelic drugs, including psilocybin and lysergic acid diethylamide (LSD), in conjunction with psychotherapy have been shown to produce rapid and sustained reductions in existential and psychiatric distress and may be a promising treatment for patients facing existential distress in palliative care settings. In this narrative review article, we describe the history of psychedelic medicine including early studies and the modern wave of research over the past 20 years, which includes high quality clinical trial data. This review outlines specific considerations for therapeutic application of psilocybin including pharmacokinetics, patient selection, dosing, protocol designs, and safeguards to reduce potential adverse effects to help guide future psychedelic practitioners. With growing public interest and evolving state level policy reforms allowing access to psychedelic treatments, it is critical for palliative care providers to gain familiarity with the current state of science and the potential of psilocybin assisted psychotherapy in the treatment of existential distress.
PMID: 39168642
ISSN: 2224-5839
CID: 5680822

Impact of Palliative Care Referral on End-of-Life Outcomes for Patients With Hematologic Malignancy

Seecof, Olivia M; Jang, Charley; Abdul Hay, Maher
CONTEXT/BACKGROUND:Compared to patients with solid malignancies, less is known about the role of palliative care in patients with hematologic malignancies, leading to underutilization of palliative care. OBJECTIVES/OBJECTIVE:Evaluate the timing and impact of palliative care referrals on end-of-life outcomes over a 5-year period with intent to improve the utilization of palliative care in patients with advanced hematologic malignancies. METHODS:A retrospective cohort of patients from an urban, NCI-designated comprehensive cancer center, aged 18 years and older with a diagnosis of an advanced hematologic malignancy were separated into groups of early, late, very late, or no specialty palliative care. Logistic regression models were constructed to examine variables associated with timing of palliative care referral. Groups were compared using the Kruskal Wallis test and Dunn's test with a Bonferroni correction method. RESULTS:222 patients with advanced hematologic malignancies who died between July 1, 20218 and June 30, 2023 were included. 50 (23%), 41 (18%), and 51 (23%) patients received an early, late, and very late palliative care referral, respectively and 80 (36%) patients did not receive a palliative care referral. There was a significantly high completion of ACP documentation among the palliative care cohorts. There was no significant difference among all cohorts in end-of-life outcomes in the last 14 or 30 days of life. CONCLUSION/CONCLUSIONS:ACP documentation improved with palliative care, however, end-of-life outcomes did not. These results are likely due to the majority of late, inpatient palliative care referrals. Future studies with targeted interventions are needed to improve these outcomes.
PMID: 39041816
ISSN: 1938-2715
CID: 5678242

Exploring the Barriers to Buprenorphine Therapy for Cancer-Related Pain and Concurrent Opioid Use Disorder: A Case Report

Seecof, Olivia M; Kuwata, Caitlyn; DiBiase, Jennifer; Popp, Beth
Although buprenorphine is widely accepted as a treatment option for opioid use disorder (OUD), it is underutilized as a treatment for cancer-related pain. Owing to its decreased side effect profile, various formulations (depending on FDA indication of pain versus OUD), and ability to simultaneously address OUD and pain, buprenorphine is gaining popularity in the outpatient palliative medicine setting. Despite these compelling benefits, there are significant barriers to initiating therapy. These barriers include clinician experience, insurance authorization, pharmacy supply, and stigma. We present a complicated case to describe the practical clinical experience of an attempt at low-dose initiation of buprenorphine to treat cancer-related pain in a patient with concurrent OUD and to discuss ways to start overcoming the encountered barriers.
PMID: 35861726
ISSN: 1557-7740
CID: 5284502

Lessons Learned From a Pilot Project on Telemedicine Advance Care Planning in an Urban Geriatric Primary Care Office

Seecof, Olivia M; Allanoff, Molly; Liantonio, John; Parks, Susan
PURPOSE/UNASSIGNED:There is a dearth of literature regarding the documentation of advance care planning (ACP) in the geriatric population, despite the controversial, yet well-studied need for ACP. The purpose of this pilot study was to provide an update to a prior study from our institution that outlined the need for increased documentation of advance care planning (ACP) in an urban geriatric population. METHODS/UNASSIGNED:Our study involved using telemedicine to conduct dedicated ACP visits and an electronic medical record (EMR) note-template specifically designed for these visits in an attempt to increase the amount of documented ACP in the EMR in this population. RESULTS/UNASSIGNED:The study did not yield significant results due to the inability to schedule enough patients for these dedicated visits. DISCUSSION/UNASSIGNED:While our study was ultimately unsuccessful, 3 crucial lessons were identified that will inform and fuel future interventions by the authors to further the study of documentation of ACP.
PMID: 34350802
ISSN: 1938-2715
CID: 5184972

Hyperpigmentation of the Tongue and Systemic Symptoms

Studdiford, James; Seecof, Olivia M; Trayes, Kathryn P; Valko, George
PMID: 32293849
ISSN: 1532-0650
CID: 5184962

Is there an oxidative cost of acute stress? Characterization, implication of glucocorticoids and modulation by prior stress experience

Majer, Ariana D; Fasanello, Vince J; Tindle, Kailey; Frenz, Brian J; Ziur, Alexis D; Fischer, Chelsea P; Fletcher, Kelsey L; Seecof, Olivia M; Gronsky, Sarah; Vassallo, Brian G; Reed, Wendy L; Paitz, Ryan T; Stier, Antoine; Haussmann, Mark F
Acute rises in glucocorticoid hormones allow individuals to adaptively respond to environmental challenges but may also have negative consequences, including oxidative stress. While the effects of chronic glucocorticoid exposure on oxidative stress have been well characterized, those of acute stress or glucocorticoid exposure have mostly been overlooked. We examined the relationship between acute stress exposure, glucocorticoids and oxidative stress in Japanese quail (Coturnix japonica). We (i) characterized the pattern of oxidative stress during an acute stressor in two phenotypically distinct breeds; (ii) determined whether corticosterone ingestion, in the absence of acute stress, increased oxidative stress, which we call glucocorticoid-induced oxidative stress (GiOS); and (iii) explored how prior experience to stressful events affected GiOS. Both breeds exhibited an increase in oxidative stress in response to an acute stressor. Importantly, in the absence of acute stress, ingesting corticosterone caused an acute rise in plasma corticosterone and oxidative stress. Lastly, birds exposed to no previous acute stress or numerous stressful events had high levels of GiOS in response to acute stress, while birds with moderate prior exposure did not. Together, these findings suggest that an acute stress response results in GiOS, but prior experience to stressors may modulate that oxidative cost.
PMCID:6892047
PMID: 31718494
ISSN: 1471-2954
CID: 5184952

Dyskeratosis Congenita and Oral Cavity Squamous Cell Carcinoma: Report of a Case and Literature Review [Case Report]

Trott, Kiley E; Briddell, Jenna W; Corao-Uribe, Diana; Powell, Jonathan; Seecof, Olivia M; Levy, Carly; Miller, Elissa G; Shah, Udayan K
Dyskeratosis congenita is a rare genetic condition of telomerase dysfunction in which patients are at an increased risk of squamous cell carcinoma (SCCa) of the oral cavity. We present here the youngest patient in the literature with a diagnosis of SCCa. We discuss the literature and management of this advanced presentation of SCCa in a child, stressing the importance of palliative care involvement in facilitating medical decision making.
PMID: 30951027
ISSN: 1536-3678
CID: 5184942

Migraine: Expanding our Tx arsenal

McGrath, Kathryn; Rague, Allison; Thesing, Claire; Collins, Elizabeth; Seecof, Olivia; Liantonio, John
Beyond tried-and-true therapies are new therapeutic targets on the horizon-giving you a bigger toolbox to help patients abort and prevent migraine episodes.
PMID: 30724899
ISSN: 1533-7294
CID: 5184932

Prognostication Using SCORTEN Severity of Illness Score in Patients With Stevens Johnson Syndrome and Toxic Epidermal Necrolysis [Letter]

Seecof, Olivia M; Liantonio, John
PMID: 30273718
ISSN: 1873-6513
CID: 5184922