Annual Meeting Proceedings Part 1 - American Society of Clinical ...

390s Health Services Research
6032 Poster Discussion Session (Board #20), Tue, 8:00 AM-12:00 PM and
11:30 AM-12:30 PM
Life expectancy (LE) and the receipt of conservative versus active treatment
in men with prostate cancer (CaP): A population-based study. Presenting
Author: Trevor Joseph Royce, UNC-CH School of Medicine, Chapel Hill, NC
Background: Prostate-specific antigen (PSA) screening increases the diagnosis
of low-risk and potentially clinically insignificant CaP, which raises
concern for possible overtreatment. The National Comprehensive Cancer
Network (NCCN) guidelines recommend surveillance (conservative management)
for patients with less than 10 years LE diagnosed with low-risk
cancer. In contrast, NCCN recommends active treatment for high-risk CaP,
the most aggressive form of this disease, irrespective of LE. We examine
patterns of care in CaP patients in the Surveillance, Epidemiology and End
Results (SEER) registry by LE. Methods: 152,578 men with non-metastatic
CaP diagnosed from 2004-8 were included. Gleason, PSA, and clinical
stage were used for risk-categorization per D’Amico criteria. The sample
was dichotomized into men 76 years and younger (who have an average LE
of 10 years or more based on the US Social Security Administration
actuarial period life tables) vs. 77 years and older (less than 10 years
average LE). Logistic regression models examined factors associated with
each treatment modality. Results: 56% of patients age 77 and older with
low-risk CaP received conservative management, and 44% active treatment
(Table). However, conservative management was just as common in
older patients with high-risk cancer (62%); 21% of younger patients with
high-risk CaP also received conservative management. Multivariable analysis
showed decreased use of conservative management over time in older
patients (OR 0.78 for 2008 vs. 2004, 95%CI 0.71-.86, p�.001). African
American race, being unmarried, and older age were also significantly
associated with conservative management. Conclusions: There may be
overtreatment of low-risk CaP patients age 77 and older, which is worsening
in recent years. Correspondingly, there appears to be undertreatment of
elderly patients with high-risk CaP, the most aggressive form of this
disease.
Percent of patients receiving each treatment stratified by CaP risk and age.
Low risk Intermediate risk High risk
�77 �77 �77
Conservative 22 56 13 47 21 62
Radical prostatectomy 35 1 50 2 39 2
Beam radiation 22 28 28 42 35 33
Brachytherapy 21 15 8 9 6 3
6034 Poster Discussion Session (Board #22), Tue, 8:00 AM-12:00 PM and
11:30 AM-12:30 PM
Do patients with advanced-stage non-small cell lung cancer (AS NSCLC)
live longer if managed within a clinical trial setting? Presenting Author:
Taher Abu Hejleh, Division of Hematology, Oncology and Marrow Transplantation,
Department of Internal Medicine, University of Iowa Hospitals and
Clinics, Iowa City, IA
Background: Treatment outcomes of AS NSCLC (stages IIIB and IV) are
poor. There is an argument that participation in a clinical trial (CT) may
confer survival benefit, probably, through enhancing quality of care. In this
study, we explore the survival outcomes and perceived care quality for AS
NSCLC patients (pts) treated within vs outside a CT. Methods: Data were
obtained from surveys of newly diagnosed AS NSCLC pts studied by the
Cancer Care Outcomes Research and Surveillance Consortium (CanCORS),
a large cohort of pts across the United States. Pts who did not complete the
baseline survey were excluded as this was associated with worse performance
status (PS). Baseline characteristics according to CT participation
were determined. Association between CT enrollment and survival was
explored utilizing univariate and multivariate survival analysis after adjusting
for age, comorbidities and self-reported PS. Results: Of 815 AS NSCLC
pts, 56 (7%) were enrolled on a CT. Chemotherapy trials comprised 67% of
all trials. Of the 815 pts, 697 (86%) died. Median survival for pts within vs
outside a CT was 62 vs 64 months. Neither age, comorbidities nor recalled
PS differed significantly between pts within vs outside a CT (P�0.2085,
0.5818 and 0.1678 respectively). On the multivariate survival model, CT
enrollment did not correlate with longer survival (P�0.8811) and only
presence of comorbidities was associated with worse survival (P�0.0021).
Comparing pts according to CT enrollment, there was no significant
difference in symptom management, receiving hospice care (P�0.606),
death location (P�0.2018), or following pts’ wishes (P�0.8321). However,
perception of the overall cancer care quality was greater among CT
enrollees (P�0.0171). Conclusions: Management of AS NSCLC pts within
a CT setting conveyed a perception of superior care that did not translate
into survival benefit after adjusting for differences in age, comorbidities,
and self-reported PS. These findings suggest that providing cancer care
within a CT should not imply a survival benefit when counseling AS NSCLC
pts about entering CTs.
6033 Poster Discussion Session (Board #21), Tue, 8:00 AM-12:00 PM and
11:30 AM-12:30 PM
Timeliness of care and stage at diagnosis of non-small cell lung cancer
(NSCLC) with the implementation of a cancer care coordination program
(CCCP) at a VA medical center. Presenting Author: Susan Alsamarai,
Yale-New Haven Hospital, New Haven, CT
Background: Timeliness of care improves patient satisfaction and may
improve outcomes. A CCCP was established in Nov 2007 to improve
timeliness of care of NSCLC patients at the Veterans Affairs Connecticut
(VACT) Healthcare System. Methods: We performed a retrospective cohort
analysis of patients diagnosed with NSCLC at VACT between 2005-2010.
We compared timeliness of care and stage at diagnosis before and after the
implementation of the CCCP. Results: Data from 352 patients was
analyzed: 163 with initial abnormal imaging between 1/1/2005 and
10/31/2007, and 189 with imaging between 11/1/2007 and 12/31/2010.
Variables associated with a longer interval between the initial abnormal
image and the initiation of therapy were: (1) earlier stage (mean of 130
days for stages I/II vs. 87 days for stages III/IV, p�0.001),(2) lack of
cancer-related symptoms (145 vs 60 days, p�0.001), (3) presence of
medical co-morbidities (111 vs 76 days, p�0.01), and (4) depression
(127 vs 98 days, p�0.029). Substance abuse increased the interval from
initial abnormal image to tissue diagnosis by 29 days (p�0.032) but did
not affect the interval from image to treatment. The mean interval between
diagnosis and initiation of treatment was 19 days longer in blacks vs.
non-blacks (55 vs 36 days, p�0.0118) although the overall time from
abnormal image to diagnosis and to treatment was not statistically
different. In a multivariate model adjusting for stage, histology, reason for
initial imaging, and presence of a primary care provider, implementation of
a CCCP resulted in a mean reduction of 25 days in the time between the
first abnormal image and initiation of cancer treatment (126 to 101 days,
p�0.0154). The percent of patients diagnosed at stages I and II increased
from 32% to 48% (p�0.0065) after the implementation of a CCCP.
Conclusions: A centralized, multidisciplinary, hospital-based CCCP can
improve timeliness of NSCLC care, and may also help ensure that
incidental, early stage lung cancers are treated.
6035 Poster Discussion Session (Board #23), Tue, 8:00 AM-12:00 PM and
11:30 AM-12:30 PM
Results of a cluster randomized trial to evaluate a nursing lead supportive
care intervention in newly diagnosed breast and colorectal cancer patients.
Presenting Author: Jonathan Sussman, Juravinski Cancer Centre, Hamilton,
ON, Canada
Background: Patient transitions during the early phases of cancer care from
initial diagnosis through oncology consultation are often poorly coordinated
resulting in unmet need, poor continuity, and resultant distress. It has been
proposed that better coordination of care during this period would improve
the care experience from the patient’s perspective. We designed a
randomized trial to test a community based nursing lead coordination of
care intervention in newly diagnosed breast and colorectal cancer patients.
Methods: Cluster randomized control trial in 193 newly diagnosed breast
and colorectal cancer patients enrolled through surgical practices within 7
days of cancer surgery in Toronto, Canada. Surgical practices were
randomized between a standardized nursing intervention and a control
group involving usual care practices. The intervention consisted of a
standardized in person supportive care assessment with ongoing supportive
care by telephone or in person that included linkage to community services
using protocol specified guidelines according to identified needs. The
primary outcomes measured at 8 weeks were validated patient reported
outcomes (PROs) of 1) unmet need (SCNS) and 2) continuity of care
(CCCQI). Secondary outcomes included 1) quality of life (EORTC QLQ-
C30), 2) health resource utilization, and 3) level of uncertainty with care
trajectory (MUIS) at 8 weeks. Results: 121 breast and 72 colorectal
patients were randomized through 28 surgical practices. The intervention
group had a median of 6 nursing contacts over the study period. There were
no differences between groups on PROs of unmet need, continuity of care,
quality of life, or uncertainty. Health service utilization did not differ
between groups. Conclusions: A specialized oncology nursing intervention
early in the care trajectory did not result in improved supportive care
outcomes for patients.
Intervention, n � 85
Mean (SD)
Control, n � 101
Mean (SD)
Difference
[95% CI]
SCNS Summary Score 2.0 (0.7) 1.9 (0.7) 0.1 [-0.3, 0.7]
CCCQI Summary Score 4.0 (0.6) 4.0 (0.5) 0.0 [-0.2, 0.2]
EORTC Global Health 66 (20) 67 (22) 1 [-5.6, 6.9]
MUIS Summary Score 46 (15) 47 (14) 1 [-5.2, 2.8]
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