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

6069 General Poster Session (Board #5B), Mon, 1:15 PM-5:15 PM
Effectiveness of a screening intervention to identify clinical-trial-eligible
patients. Presenting Author: Leo Chen, University of British Columbia,
Vancouver, BC, Canada
Background: Advancements in cancer therapy require clinical trials, but
only 3% of all cancer patients (CP) participate in trials causing many
studies to be delayed or fail to complete. Literature indicates that accrual to
clinical trials is primarily driven by MD related factors. The objective of this
study was to evaluate whether the screening and identification of potentially
eligible patients (PEP) for specific clinical trials would lead to an
increased rate of accrual (RA). Methods: During a 4 month period, the
charts of CP attending the outpatient clinics of 12 MDs were reviewed to
determine eligibility for 21 phase II-IV trials for CP with BR, GI, GU, GY, or
LG cancer. Trials were included if they had been open for � 4 months and
would remain open � 8 months from the start of the intervention. A
screening coordinator with minimal clinical background reviewed the
electronic record of new and followup CP to determine eligibility according
to protocol specified criteria. PEP were identified for medical oncologist by
attaching notices to CP charts. Participating MDs were surveyed regarding
the helpfulness and accuracy of the forms. A negative-binomial regression
model was used to compare RA and find 95% CI for relative rates. Results:
Between May 1 to August 31, 2011 a total of 2,098 charts were screened
for eligibility for 21 trials, and 120 PEP were identified. Of these, 15 were
randomized to the referred study, 4 to a different study, and 4 CP were
offered but declined the referred study. Four month RA for included trials
were 61 before, 73 during and 51 after the intervention. Relative rates
adjusted for MD bookings were 0.85 (95% CI: 0.67, 1.06, p � 0.15)
before and 0.70 (95% CI: 0.54, 0.90, p � 0.005) after, relative to during
the intervention. 33 completed questionnaires were received: 22 (67%)
were helpful and 23 (70%) were accurate. Screening required a 1.0 Full
Time Equivalent position during the period of the intervention. Conclusions:
Manual screening of patient records to determine clinical trial eligibility is
labor intensive and increases enrolment to specific clinical trials. Notifications
were deemed mostly helpful and accurate by oncologists. Screening
interventions should be considered to improve clinical trial accrual.
6071 General Poster Session (Board #5D), Mon, 1:15 PM-5:15 PM
Burnout prevalence in medical and radiation oncologists at British Columbia
Cancer Agency (BCCA). Presenting Author: Catherine A. Fitzgerald, BC
Cancer Agency, Vancouver Island Centre, Victoria, BC, Canada
Background: Burnout, reported to affect 30-60% of oncology workers, is a
syndrome of psychological distress typically manifesting in three dimensions:
Emotional Exhaustion (EE), Depersonalization (DP) and Low Personal
Accomplishment (PA). Causal factors include workload, dealing with
terminally ill patients and difficulties maintaining a balance between
professional and personal life. As workload rises due to increased complexity
of therapy and increasing prevalence of cancer patients, burnout may
increase, especially in times of financial constraint. We sought to determine
the prevalence of burnout in medical and radiation oncologists
working at BCCA, which provides all radiation and the majority of medical
oncology services to BC’s 4.5 million people. Methods: In March 2011,
BCCA oncologists were invited to participate in a confidential online survey
consisting of basic demographics and the 22 item MasLach Burnout
Inventory (MBI) instrument, the latter a validated tool measuring distress in
the three main dimensions of burnout. Normative data for physicians were
used to interpret the results. Results: Response rate was 59%, female:male
40:60% with similar response rates for medical and radiation oncology (60
v 59%). Of the 73 who indicated their age range, 34 (47%) were between
35 and 44 years old. Respondents indicated that they had considered
reducing their Full Time Equivalent (FTE) (67%) or leaving BC (46%). In
those with at least 2 scores at a severe level, these rates were 76% and
71% respectively. Conclusions: Over 60% of responding BCCA oncologists
report burnout in at least one domain of the MBI tool. Many have
considered leaving the province or reducing their hours. These data are
consistent with Grunfeld’s survey of Ontario oncologists (CMAJ 2000),
although the rate of burnout is higher in this survey. Further research into
ways to lessen burnout in oncology is urgently needed.
Percentage of responding BCCA oncologists (n�78) with “severe” score on
burnout (MBI) survey.
Burnout factor
Emotional
exhaustion Depersonalization
% scores at
“severe”
level
Low personal
achievement
At least
1 factor
More
than
1 factor
All 3
factors
51% 44% 28% 64% 44% 14%
Health Services Research
399s
6070 General Poster Session (Board #5C), Mon, 1:15 PM-5:15 PM
Disparities in the treatment and outcomes of lung cancer among HIVinfected
people in Texas. Presenting Author: Gita Suneja, Department of
Radiation Oncology, University of Pennsylvania School of Medicine, Philadelphia,
PA
Background: HIV-infected (HIV�) people are at elevated risk for lung cancer
and have higher mortality following lung cancer diagnosis than uninfected
(HIV-) individuals. The disparity in survival is partly due to advanced stage
at diagnosis, but it is unclear whether HIV� people with lung cancer are
less likely to receive cancer treatment, which could worsen survival.
Methods: We included adults � 18 years of age with lung cancer reported to
the Texas cancer registry (N�156,930). HIV status was determined by
linkage with the enhanced Texas HIV/AIDS Reporting System. We compared
HIV� and HIV- lung cancer cases with respect to demographic and
clinical characteristics. For non-small cell lung cancer (NSCLC) cases, we
identified predictors of cancer treatment (surgery, radiation, and chemotherapy)
using logistic regression. We used Cox regression to evaluate the
effects of HIV and treatment on lung cancer-specific mortality. Results:
Compared with HIV- lung cancer cases (N�156,593), HIV� lung cancer
cases (N�337) were more likely to be young, non-Hispanic black, male,
and to have distant stage disease (53.7% vs. 44.4%). HIV� cases were
less likely to receive cancer treatment than HIV- cases (60.3% vs. 77.5%;
odds ratio 0.39, 95%CI 0.30-0.52 after adjustment for diagnosis year,
age, sex, race, stage, and histologic subtype). In Cox models adjusted for
these variables, both HIV infection (hazard ratio [HR] 1.34, 95%CI
1.15-1.56) and lack of cancer treatment (HR 1.69, 95%CI 1.66-1.72)
were associated with higher lung cancer-specific mortality. After adjustment
for cancer treatment, the association between HIV and lung cancer
mortality was attenuated (HR 1.25, 95%CI 1.06-1.47). The association
between HIV and lung cancer-specific mortality was stronger among
untreated lung cancer cases (HR 1.32, 95%CI 1.01-1.72) than treated
cases (adjusted HR 1.16, 95%CI 0.94-1.43; p-interaction�0.34).
Conclusions: In this population-based study, HIV� people with NSCLC were
less likely to be treated for lung cancer than their HIV- counterparts. This
lack of treatment may be partly responsible for higher cancer-related
mortality in HIV� cases. Further investigation is needed to understand
disparities in cancer treatment for HIV� people.
6072 General Poster Session (Board #5E), Mon, 1:15 PM-5:15 PM
Clinical and cost impact of diagnostic slide review. Presenting Author:
Justin Cuff, Aegis Review, San Francisco, CA
Background: Diagnostic error is postulated to represent a significant source
of preventable mortality, morbidity, and cost. A primary pathologic diagnosis
of cancer has a relatively high error rate necessitating cost effective
solutions to mitigate diagnostic related harm. Methods: A review of 773
consecutive inbound transfers to Stanford, with review of prior pathology
material, was performed to measure diagnostic discrepancy. Information
was collected about the originating practice size and type, subspecialty
area, additional testing, and a description of the disagreement. For a subset
of cases, itemized payment data was collected to explore the financial
impact of slide review. Results: We found that 9% of cases have diagnostic
discrepancies when comparing the incoming working diagnosis with the
result of the pathology slide review. Major diagnostic discrepancies, likely
to alter treatment, were identified in 3% of cases. Discrepancy rates
differed significantly between subspecialty areas (p�0.01) although few
areas were spared major error. Disagreements about classification were
common as were over/under calling malignancy, grading errors, and
incorrect ordering or interpretation of ancillary testing. The subset of cases
(n�107) with billing information demonstrated ~42,800 unique charge
events associated with these episodes of care. The mean charge for patients
was $292,813 (median $130,467). Typical of charge data the dollar
amounts exhibited strong right-skew. Average reimbursement was $76,017
(median $23,999) and the median charge:reimbursement ratio was 3.3.
When analyzing cases by service line, only 1.4% of charges related to the
diagnostic review of the prior pathology material, demonstrating a remarkably
small impact on the overall cost. While additional testing was
performed on 10% of cases, there was no evidence that cases with a
discrepancy were associated with increased overall costs. Conclusions:
Diagnostic slide review on prior material is relatively inexpensive in terms of
the cost of overall care and permits the detection of significant errors that
may affect treatment planning. Pathology slide review represents a clinically
impactful and low cost way to prevent errors in diagnosis from
becoming errors in management.
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