EAPC - ipac

446 EAPC Abstracts
Background: For decades there has been debate about the best way to ask
patients to rate pain severity. A range of methods has been advocated,
including numerical rating scales from 0 “no pain” to 10 “worst possible
pain” (NRS-11), verbal rating scales with between 4 (VRS-4) to 7 (VRS-7)
response options labelled with verbal descriptors, and visual analogue
scales (VAS). There is extensive literature in the social sciences about rating
scales, mainly dating from the 1950s to the late 1980s, as well as a number
of publications about pain assessment. Two themes emerge. Firstly,
determination of the optimal number of response options when using NRS
or VRS scales. Secondly, comparison of VAS scales against NRS. The exact
number of response options used in a scale is important. One or two extra
options may increase reliability and better reflect the patient-to-patient variability.
But, lengthier scales may increase the time to complete questionnaires,
and place greater cognitive demands on frail patients. Aim: To
review literature on rating scales, supplemented by empirical analyses of a
pain database. Data and statistics: Patient data collected as part of the
EPCRC project have been analysed by item response theory. Conclusions:
Historical studies suggest that VRS with up to 7 options are increasing more
powerful than VRS-4; VRS-5 to VRS-7 are generally preferred by patients
as providing richer and more appropriate choice of response options. The
two main contenders are NRS-11 and VRS-7. Results from analyses of
EPCRC data are consistent with this hypothesis.
Poster N°: 156
Type of presentation: Poster
Poster session: First Group 29 May Thursday, 10.30 to 30 May Friday
13.00
Category: Assessment & measurement tools
Title: Outcomes in Patients Who Had Undergone Internal Hemipelvectomy
(IH) versus External Hemipelvectomy (EH)
Authors:
Ying Guo Palliative Care and Rehabilitation Medicine M. D. Anderson
Cancer Center U. STATES
Karen Zhang M. D. Anderson Cancer Center Houston U. STATES
Be-Lian Pei M. D. Anderson Cancer Center Houston U. STATES
Jeanine Hanohano M. D. Anderson Cancer Center Houston U. STATES
Christina Cote M. D. Anderson Cancer Center Houston U. STATES
J. Lynn Palmer M. D. Anderson Cancer Center Houston U. STATES
Gunjan Sharma M. D. Anderson Cancer Center Houston U. STATES
Guddi Kaur M. D. Anderson Cancer Center Houston U. STATES
Eduardo Bruera M. D. Anderson Cancer Center Houston U. STATES
Background: Introduction: Hemipelvectomy is necessary in treatment of
malignant pelvic tumors. This study compares the rehabilitation need and
functional outcome of patients undergoing an IH versus EH. Methods:
Charts from 30 patients who underwent IH and 30 patients who underwent
EH during 1993–2005 were reviewed. Information collected
include: demographic data; tumor diagnosis and treatment received; postoperative
hospital length of stay (LOS); whether patient required physiatrist
consult and/or acute inpatient rehabilitation stay; the length of rehabilitation
stay; patients’ functional independence measure (FIM) score for
gait upon discharge. We compared differences between the IH and EH
groups using the Wilcoxon rank sum test, Chi-square test, and Fisher’s
exact test. Results: The mean age (range) for IH was 47 (8–80) and 44
(12–75) for EH groups. The male gender was 22/30 (73%) for IH and
15/30 (50%) for EH groups. The preoperative chemotherapy and radiation
treatment are similar between IH and EH groups (p=0.11 and 0.37)
respectively. Rehabilitation consultation and acute in-patient rehabilitation
stay was required for IH group 15/30 (50%) and 13/30 (43%); for EH
16/30 (53%) and 16/30 (53%) respectively (p= 0.8, and 0.44) respectively.
The mean (range) hospital LOS for patients who underwent EH was
significantly longer than those who underwent IH (37 vs.19, p=0.0035).
The mean rehabilitation LOS was similar (20 for EH vs. 22 days for IH
patients, p=0.83). At the time of discharge, significantly higher percent of
IH patients were able to ambulate without another person’s assistance
14/30 (47%) vs. 5/30 (17%) in EH patient group, p=0.0125.
Conclusions: Internal hemipelvectomy with limb salvage seems to be
advantageous over external hemipelvectomy, in both hospital LOS and
short-term functional recovery.
Poster N°: 157
Type of presentation: Poster
Poster session: First Group 29 May Thursday, 10.30 to 30 May Friday
13.00
Category: Assessment & measurement tools
Title: Karnofsky Index and survival
Authors:
Eva Gyllenhammar Löwet Närvård AB ASIH SWEDEN
Jan Adolfsson Onkologiskt centrum Karolinska Universitetssjukhuset Solna
SWEDEN
Eva Thoren-Todoulos ASIH Löwenströmska sjukhuset SE-194 89 SWEDEN
Background: Previous studies have shown that Karnofsky Performance
Index (KPI) < 40 is associated with shorter survival time. In a palliative
home care setting it would be of great value to have easily accessible
tools to assess prognosis in terms of survival. Methods: All patients
admitted to our advanced home care team during 30 months were
assessed with KPI at the first home visit. The patients hade both nonmalignant
and malignant diagnosis and were all in a palliative stage of
their disease. KPI was noted in the electronic file of each patient and the
file could not be completed without the assessment. Six senior doctors
were involved. Results: 579 consecutive patients were included.
One(1)KPI assessment was missing. 152 patients had non-malignant diseases
and 426 had a disseminated cancer with rapidly progressing disease.
The mean KPI at admission was 70. In the non-malignant group
13 % (20/152) died during the study period, and in the cancer group 65%.
(279/426) In the non-malignant group 52 % of the patients had a KPI
equal 60 or lower at admission. The corresponding figure for the cancer
patients was 31 %. For the group as a whole (579 patients) no correlation
was found between KPI and time of survival. In the non-malignant group
there was likewise no correlation to be found. In the malignant group
there was a correlation between KPI and time of survival, which is significant
at the 0,01 level. Conclusions: Our conclusion is that KPI on its
own is not a useful tool to estimate prognosis in terms of time of survival
in a mixed palliative patients’ population. The non-malignant patients
hade a poorer KPI score at admission but a much better survival. In a palliative
cancer patient group KPI might be useful but still approximately
20 % of the patients were “long term survivors”.
Poster N°: 158
Type of presentation: Poster & poster discussion session
Poster session: First Group 29 May Thursday, 10.30 to 30 May Friday
13.00
Category: Assessment & measurement tools
Title: The Alberta Breakthrough Pain Assessment Tool for Research:
A Validation Study
Authors:
Neil Hagen Oncology Tom Baker Cancer Centre and University of Calgary
CANADA
Cheryl Nekolaichuk University of Alberta Edmonton, Alberta CANADA
Patricia Biondo Tom Baker Cancer Centre, Alberta Cancer Board Calgary,
Alberta CANADA
Linda Carlson Alberta Cancer Board and University of Calgary Calgary,
Alberta CANADA
Carla Stiles Tom Baker Cancer Centre, Alberta Cancer Board Calgary,
Alberta CANADA
Kim Fisher Alberta Cancer Board Calgary, Alberta CANADA
Robin Fainsinger Alberta Cancer Board and University of Alberta
Edmonton, Alberta CANADA