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Annals of Oncology
grade 4 toxicity were observed, hematological and non hematological grade 3
toxicities were observed in 12.21% and 13.8% of pts, respectively. In the adults, grade
4 hematological and non hematological toxicity were observed in 3.8% and 1.9% of
pts, respectively; grade 3 hematological toxicity in 23.2% and non hematological
toxicities in 21.3% of pts. The difference was statistically significant (p = 0.042) in
favor of the elderly. At September 2011, 234 pts were assessable for response: the
ORR was 50.7% for elderly and 51.1% for adults. No differences were observed for
quality of life and dose intensity between the two groups. PFS was 10.6 mo. (3-12 +
mo) for elderly and 9.05 mo. (3-12 + ) for adults.
Conclusion: The promising results of this single Institution study warrant to be
confirmed by a larger clinical trial.
Disclosure: All authors have declared no conflicts of interest.
1605P OPINIONS OF NURSES ON THE APPLICATION AND
IMPLICATIONS OF DNR/DNI ORDERS
I.C. Glitza 1 , H.J. Conter 1 , R. Turner 2 , S.K. Reddy 3 and E. Bruera 4
1 Division of Cancer Medicine, MD Anderson Cancer Center, Houston, TX,
UNITED STATES OF AMERICA, 2 Palliative Care, Albert Einstein Medical Center,
Philadelphia, PA, UNITED STATES OF AMERICA, 3 Department of Palliative Care
and Rehabilitation Medicine, MD Anderson Cancer Center, Houston, TX,
UNITED STATES OF AMERICA, 4 Palliative Care and Rehabilitation Medicine, M.
D. Anderson Cancer Center, Houston, TX, UNITED STATES OF AMERICA
Background: Although do not resuscitate (DNR)/ do not intubate (DNI) orders have
a technically limited mandate, the implication of such orders may be broad.
Moreover, the patient factors that may influence healthcare providers’ decisions may
be debated. This study aimed to evaluate nurses’ opinions on DNR/DNI orders.
Methods: The study was conducted as an anonymous, single institution survey.
Fulltime nurses (RNs) were identified by payroll and received a questionnaire.
Nurses’ demographics and background, their rating of factors leading to DNR/DNI
and rating of appropriateness of treatments were obtained.
Results: Of the 350 distributed surveys, 83% were returned. Work locations included
general floors (47%), intermediate care (21%) and ICU (32%). Sixty-seven percent
were ≤ 40 years old, 88% were female, and 73% had ≤ 10 years of work experience.
204 RNs felt that DNR/DNI orders influence treatment choices of physicians, 81%
felt they should be more included in the discussion process. Female RNs were more
likely to change the amount of time spent at bedside (OR 0.32, 95%CI 0.12-0.92) and
they felt that physician’s treatment choices were influenced by DNR orders (OR 0.36,
95% CI 0.17-0.74) compared to males. From an RN view, most important factors
leading to a DNR/DNI order were patients’ wishes (99%), untreated/untreatable
cancer (94%) and quality of life before admission (89%). For less experienced RNs,
there was a general trend to support the administration of blood products,
antibiotics, feeding tube placement, invasive procedures, vasopressors, and ICU
transfer. Their support for hemodialysis was the only variable that was statistically
significant (OR 1.74, 95% CI 1.03- 2.97). Pooled analysis demonstrated that less
experienced were more likely to support a more agressive treatment approach (OR
1.41, 95%CI 1.17-1.71, i^2= 0%).
Conclusion: Nurses regard patients’ wishes, quality of life, serious diseases as the
most important factors leading to a DNR/DNI order. Less experienced nurses favor a
more aggressive treatment approach. Nursing staff feel that they should be a vital part
of the DNR/DNI discussion. Further continuous education of the whole health care
team on the meaning and implication of DNR/DNI orders is mandated.
Disclosure: All authors have declared no conflicts of interest.
1606P PARENTAL CANCER: REVIEWING THE CONCERNS OF
BREAST CANCER PATIENTS WITH CHILDREN
E. Miura and T. Ishida
Child Support, St.Luke’s International Hospital, Tokyo, JAPAN
Background: In recent years, it is estimated that 24% of cancer patients have a child
under 18 years of age. Affected parents may experience heightened distress related to
the worries about their illness as well as their inability to perform parenting
activities. Many parents also struggle with what and how to tell their children about
their own or their loved one’s illness and future. Since 2008, St. Luke’s International
Hospital (Tokyo, Japan) started a service called “Child Support”, for these patients to
discuss their concerns, providing them with appropriate suggestions and useful
resources.
Objective: The objective of this research is to review and organize the concerns
breast cancer patients with children have, and to review the types of support
provided by the professionals.
Method: Medical charts of breast cancer patients with under aged children, who
were offered to a child support service between the period of April 2010 and
November 2011, were reviewed (n = 172).
Result: 75% of the child support sessions started from the direct offering by the
Child Life Specialist (CLS). Nurses were slightly more active in referring the patients
to the service. 70% of the patients’ concerns were topics that directly related to their
children. The two most common concerns were “confrontation to the children about
parent’s illness” (30%), and “how the illness will impact the child” (40%). While less
than 10% showed absolutely no concern, others showed concerns in topics related to
one’s own illness (