Patients with advanced cancer and their caregivers experience a substantial amount of anxiety and distress. The purpose of this study was to assess the feasibility, acceptability, and preliminary effects of an 8-week, remotely delivered Resilient Living Program (RLP) for adult patients with advanced cancer and their caregivers.

Eligible patients included adults (≥18 years) with advanced cancer. Their caregiver had the option to participate. The RLP components included online modules, a print journal, and 4 video-telehealth-delivered sessions. Content focused on techniques for managing stress and building resilience (mindful presence, uplifting emotions, reframing experiences through practicing principles of gratitude, compassion, acceptance, meaning, and forgiveness). Feasibility and acceptability were assessed quantitatively and with semi-structured interviews conducted with a subset of participants. Effectiveness measures (anxiety, stress, quality of life [QOL], sleep, resiliency, and fatigue) were administered at baseline, week 5, week 9, and week 12.

Of the eligible patients, 33/72 (46%) were enrolled. In all, 15 caregivers enrolled. Thirty participants (21 patients/9 caregivers) completed at least 3 video-telehealth sessions (63% adherence). For patients, there were statistically significant improvements in anxiety and fatigue at week 12 (p = 0.05). Other effectiveness measures (stress, QOL, sleep, resiliency) showed positive trends. Eleven participants were interviewed and qualitative analysis revealed 4 themes: Easy to Use, Learning Key Principles, Practice is Essential, and Examples of Benefits.

Participation in the RLP was feasible and acceptable for patients with advanced cancer and their caregivers. Participants tended to indicate that the practices were easy to integrate into their everyday lives, engendered their ability to focus on the positive, and would recommend the RLP to other individuals living with advanced cancer. Preliminary effectiveness data suggest the program may positively impact anxiety, stress, QOL, sleep, resiliency, and fatigue. A larger randomized clinical trial is warranted to confirm these preliminary findings.

Concurrent electroencephalography (EEG) during neuropsychological assessment offers a promising method to understand realtime neural and cognitive processes during task performance. For example, previous studies using experimental tasks suggest that midline-frontal theta power (MFT) could serve as a measure of mental exertion and subjective difficulty. The RBANS provides an opportunity to examine this issue in neuropsychological assessment, as a widely-used screening battery that was explicitly developed with subtests that vary according to difficulty within its five domains. This study investigated the effects of task difficulty, cognitive domain, and age on elicitation of MFT during rest and RBANS administration.

EEG was recorded during eyes-closed and eyes-open resting periods and RBANS administration in a sample of 45 healthy younger adults (n = 21; mean age = 23.29, SD = 3.27, range = 19-33; 48% female) and older adults (n = 24; mean age = 70.58, SD = 5.77, range = 59-83; 83% female). MFT was defined as the highest peak above the overall power spectrum within 4-8Hz from electrode Fz, and operationalized as a binary variable (present/absent). A multilevel generalized logistic regression model was run to assess the main effects of Age (Younger, Older), Difficulty (Easy, Hard), Domain (Rest, Immediate Memory, Visuospatial/Constructional, Language, Attention, Delayed Memory), and their potential interactions, on the presence of MFT.

In the full sample, the Coding, Figure Recall, and Picture Naming subtests were numerically most likely to elicit MFT (71.1%, 66.7%, and 62.2%, respectively), whereas Semantic Fluency, Eyes-Closed Rest, and List Recall had the lowest likelihoods (37.7%, 31%, 28.9%). Older adults were also numerically less likely to exhibit MFT (37.50% present) compared to younger adults (62.24% present). An analysis of deviance revealed a significant effect of Age (F(1,43) = 7.22, p = .01) and a significant interaction between Difficulty and Domain (F(5,220) = 4.78, p < .001). Specifically, Hard subtests in the Visuospatial/Constructional (Figure Copy; b = -2.63, p < .05) and Language (Semantic Fluency; b = -2.92, p < .01) Domains were less likely to elicit MFT than the Easy subtests (i.e., Line Orientation and Picture Naming, respectively).

Results indicated that MFT can be reliably measured during neuropsychological assessment, and varies in relation to both age and task-related factors. Consistent with previous studies, older adults exhibited less MFT than younger adults in general, possibly suggesting a failure to recruit the relevant networks. Further, present findings suggest that the presence of MFT varies not only by the type of task but also by the level of difficulty. Future research with larger samples can clarify whether and how the amount of MFT elicited during specific subtests relates to objective and subjective difficulty. Overall, MFT can reliably be elicited by cognitive tasks and bears further study as a measure of real-time neural expenditure.

Urine drug testing (UDT) plays a significant role in monitoring patients on chronic opioid therapy (COT) for non-medical opioid use (NMOU). UDT, at times, can be inconsistent and misleading. We present a case where a patient on a buprenorphine patch had false negative results.

A female in her 70s with metastatic breast cancer presented with uncontrolled pain from a T6 compression fracture. She had no relief with tramadol 50 mg every 6 hours as needed. Due to an allergic reaction to hydromorphone, our team prescribed a buprenorphine patch of 5 μg/h. Subsequently, she expressed excellent pain control, and the clinician confirmed the patch placement on examination. She underwent a UDT during the visit. The UDT was negative for both buprenorphine and its metabolites. The literature review showed that false negative UDT results are relatively common among patients with low-dose buprenorphine patches. The combination of a thorough physical examination, a review of the Prescription Drug Monitoring Program, and reassuring scores on screening tools placed her at low risk for NMOU.

Buprenorphine has a ceiling effect on respiratory depression and a lower risk for addiction. However, when used in low doses, the drug might not have enough metabolites in the urine, leading to a false negative UDT. Such results might affect patient–physician relationships.

In addition to the UDT, a thorough history, screening for NMOU, physical exam, a review of PDMP, and a good understanding of opioid metabolism are necessary to help guide pain management.