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

6052 General Poster Session (Board #3A), Mon, 1:15 PM-5:15 PM
Influence of comorbidity on guideline concordant care for breast cancer:
Findings from the Center for Disease Control and Prevention National
Program of Cancer Registry (NPCR) patterns of care study. Presenting
Author: Gretchen Genevieve Kimmick, Duke University Medical Center,
Durham, NC
Background: Comorbidity burden predicts cancer treatment and may
influence outcome. We explore the relationship of specific comorbid
illnesses with receipt of guideline concordant care for early stage breast
cancer. Methods: The NPCR’s Patterns of Care study reabstracted the
medical records of breast cancer cases diagnosed in 2004 from 7 cancer
registries. We included women with nonmetastatic in situ and invasive
breast cancer, known hormone receptor status, node status, and tumor
size. Guideline-concordant management, including surgery, radiation,
chemotherapy and endocrine components, was based on NCCN guidelines
using tumor size, nodal and hormone receptor status. Comorbidity was
measured according to the Adult Comorbidity Evaluation Index (ACE).
Multivariate logistic regression models were used to determine factors
associated with guideline-concordant care, and included overall ACE
scores and 26 separate ACE comorbidity categories, as well as age, race,
hormone receptor status, and HER2 status. Results: The study sample
included 6904 women (mean age 58.7 and range 20-99 years, 76% white,
45% with ACE comorbidity score of 0, 70% ER and/or PR�, 13%
HER2�). Overall, 64% received guideline-concordant care. Receipt of
guideline-concordant care varied by overall comorbidity burden (71% for
none; 65% for minor; 63% for moderate; 50% for severe; p�0.05). The
presence of hypertension (OR 1.26, 95% CI 1.08-1.48) predicted receipt
of guideline concordant care, whereas, peripheral artery disease (OR 0.44,
95% CI 0.21-0.93), diabetes (OR 0.78, 95% CI 0.63-0.97) and dementia
(OR 0.31, 95% CI 0.13-0.74) predicted lack of guideline concordant care.
Older age, black race, and hormone receptor positivity were associated with
less, and HER2 positivity with receipt of more guideline-concordant care.
Conclusions: Overall those with more comorbidity burden received less
guideline-concordant care. However, the effects vary by specific conditions.
The odds of receiving guideline-concordant care was greater in those
with hypertension and less in those with peripheral arterial disease,
diabetes, and dementia.
6054 General Poster Session (Board #3C), Mon, 1:15 PM-5:15 PM
A brief educational intervention to increase communication about complementary
and alternative medicine (CAM) in community oncology settings.
Presenting Author: Lorenzo Cohen, University of Texas M. D. Anderson
Cancer Center, Houston, TX
Background: The widespread use of CAM in academic oncology settings has
been well documented. However, there is a lack of communication between
patients and health care professionals on CAM that may have negative
health consequences. No comprehensive study of CAM use in community
oncology settings exists. We examined the benefits of a brief educational
intervention on nurse discussions of CAM with patients. Methods: A
multi-site, randomized trial of an educational intervention (brief video,
resource list) designed to encourage oncology nurses to discuss CAM use
with their patients was conducted within the MD Anderson CCOP network.
Nurses (N�175) and patients (baseline N�699 and different set of
patients after intervention N�650) completed questions about CAM use,
communication, and knowledge. Results: Nurses were 97% female, 96%
non-Hispanic white. Two months after the intervention, nurses in the
intervention group reported that they were more likely to ask about CAM use
than those in the control group (OR�4.2; p�.005) and asked more of their
last 5 patients about CAM use (p�.003). No significant intervention effect
was found for the proportion of patients in the clinic who indicated they
were asked about CAM use after the intervention (OR�1.6, p�.10).
Approximately 40% of patients reported using CAM following their cancer
diagnosis yet the majority of nurses estimated less than 25% of their
patients used CAM. Conclusions: CAM use in community-based oncology
patients is high and there is an underestimation of use by the oncology
nurses. This very brief intervention significantly improved how often nurses
reported asking patients about their CAM use. However, the patients of the
nurses did not reflect this change in communication. Additional types of
interventions are needed to increase communication between patients and
nurses.
Health Services Research
395s
6053 General Poster Session (Board #3B), Mon, 1:15 PM-5:15 PM
Examining patient choices for metastatic breast cancer drugs. Presenting
Author: Mary Lou Smith, Research Advocacy Network, Plano, TX
Background: Patients with metastatic breast cancer face difficult drug
decisions. Our previous research (ASCO Proc 2011, abstr 6044) focused
on general benefit and toxicity showed that conjoint analysis (CA) allows
patients to express preferences; our current research quantifies patient
preference for specific drug profiles (capecitabine and paclitaxel). Methods:
Research Advocacy Network and CBWhite conducted research using CA for
DOD Center of Excellence for Individualization of Therapy in Breast Cancer.
An online survey was sent by four breast cancer organizations (N�641).
Questions elicited views on trade-offs between benefit and type/severity/
duration of toxicity. CA questions present pairs of hypothetical treatments
and ask respondents their preferred alternative; a follow-up question asks
whether the person would take the treatment if it were the only option
available. Analysis of response patterns allows study of treatment preferences
for combinations of benefit and described toxicity. Results: See table.
Preferences show much greater attention to benefit than to toxicity. When
CA is used to examine impact of biomarkers, focus on benefit continues.
Paclitaxel profile (IV) set with moderate PN lasting 1 year post treatment:
with 33% benefit LH, 6% of respondents change treatment decision if
biomarker predicts 27% vs 60% toxicity likelihood; with 27% toxicity LH,
22% of respondents change treatment decision if biomarker predicts 20%
vs 50% benefit likelihood. Conclusions: For patients with metastatic
disease, CA shows much greater attention to benefit than toxicity, and high
likelihood to take treatment with at least 30% chance of benefit for any
toxicity tested here. These results suggest biomarkers (for the profiled
drugs) predicting benefit are more likely to be used to affect patient
treatment decisions than biomarkers for toxicity.
Prediction of % selecting treatment with benefit and toxicity likelihood (LH)
under two scenarios (N�641).
10%
Toxicity LH
20% 40% 60%
IV drug profile—moderate peripheral neuropathy (PN) for 1 year
Benefit LH
20% N/A 77.4 72.3 65.3
30% N/A 89.8 86.4 81.6
50% N/A 97.1 96.1 94.3
Oral drug profile—moderate Hand-Foot Syndrome during treatment
10% 67.6 65.2 60.8 N/A
30% 94.7 93.0 91.4 N/A
50% 99.0 98.3 97.4 N/A
6055 General Poster Session (Board #3D), Mon, 1:15 PM-5:15 PM
Self-reported conflicts of interest (sfCOI) of authors and the interpretation
of randomized phase III trials (RCT) and related editorials (REd) in cancer
research. Presenting Author: Giovanni Mendonca Bariani, Instituto do
Cancer do Estado de Sao Paulo, Sao Paulo, Brazil
Background: Growing participation from industry in cancer research has
resulted in increased reporting of COI. We aimed to test any association
between author’s conclusion and sfCOI in cancer studies. Methods: All RCT
and REd published in 6 major cancer journals in a 3.5 year period were
selected. Two investigators blinded to COI disclosure independently
analyzed each RCT and REd, classifying authors’ conclusions as highly
positive, positive, neutral, negative, and highly negative with respect to
author’s opinion on the experimental therapy. The agreement rate between
investigators for conclusion classification was 90% (consensus was achieved
for the remaining 10%). We also collected data on study results, COI and
sponsorship. COI was defined as any self-reported financial tie between
author and industry except for research funds. Predictors of positive/highly
positive conclusions of RCT and of REd were tested separately in logistic
regression multivariable models. Results: From Jan 2008 to Oct 2011,
1,485 articles were retrieved: 150 RCT and 140 REd were eligible. Among
the RCT, 82 (55%) were positive, and 78 (52%) were entirely or partially
funded by industry. Any sfCOI was present in 103 (69%) RCT and in 71
(47%) REd. Conclusions of REd and RCT were: 7.3% and 11.3% highly
positive, 42.7% and 57.3% positive, 8.0% and 2.0% neutral, 29.3% and
18.7% negative, and 12.7% and 10.7% highly negative, respectively.
Multivariable analysis showed that RCT positive result was the only
significant predictor for positive conclusion by RCT authors (OR�109,
95% CI: 21-567; p�0.001). The only factor associated with positive
conclusions of REd authors was a positive conclusion by RCT author
(OR�42, 95% CI: 7-244; p�0.001). While 64 (43%) RCT reported
negative results, 103 (68.7%) RCT authors interpreted studies positively.
Logistic regression for discordance between RCT result and RCT conclusion
did not find any association with COI. Conclusions: Theinterpretation of RCT
results by authors was not influenced by sfCOI or trial sponsorship. Authors
of REd were not influenced by study results or by their sfCOI when
discussing cancer RCT.
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