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

6085 General Poster Session (Board #7B), Mon, 1:15 PM-5:15 PM
Physical activity (PA) and physical function (PF) in adult cancer survivors
(CS). Presenting Author: Peter Crawford Birks, British Columbia Cancer
Agency, Vancouver, BC, Canada
Background: The longevity of CS is increasing, underscoring the importance
of lifestyle modifications and preventive care, consisting of regular PA and
maintenance of PF. Our aims were to 1) compare PA and PF among
short-term CS, long-term CS and non-cancer controls (NCC) and 2) identify
other clinical factors associated with decreased PA and PF. Methods: We
identified CS and NCC from the US National Health and Nutrition
Examination Survey (NHANES). CS were categorized into �/�5 (shortterm)
and �5 years (long-term) based on date of diagnosis. Multivariate
weighted regression models were constructed to examine for differences in
28 and 26 measures of PA and PF, respectively, while controlling for age,
gender, ethnicity, education, income, and other confounders. We explored
specific and general PA domains such as aerobic activity and decline from
past activity level as well as PF areas including ADLs, IADLs and mobility.
Results: In total, 26,185 subjects were identified: 968 short-term CS,
1,367 long-term CS, and 23,832 NCC. For the entire cohort, the mean age
was 50 years, 52% were men, and 50% were white. Comparing across the
3 patient groups, CS were generally older than NCC (60 vs 45 years,
p�0.01). In terms of PA, short-term CS reported less general activity
compared to 1 year ago (OR 0.58, 95%, CI 0.46-0.73, p�0.01) than
long-term CS and NCC. In comparison to NCC, both groups of CS also
described less current activity than their baseline from 10 years ago (OR
0.63, 95% CI 0.48-0.82, P�0.001 and OR 0.67, 95% CI 0.55-0.83,
P��0.01). There were significant differences among patient groups in
several areas of PF (Table). Other factors that were associated with lower PA
and PF included advanced age, low education, and low income. Conclusions:
PA between CS and NCC were similar, although current activity as
compared to that of the preceding year or past decade appears lower in CS,
which may reflect their older age. Impairments in several measures of PF
were observed among CS, which could impact their quality and quantity of
life.
Limited work
OR (95%CI) p
Limited
mobility OR
(95%CI) p
Limited
leisure
activities OR
(95%CI) p
NCC 1.00 0.01 1.00 0.02 1.00 0.05
CS 5y 1.61 (1.3-1.9) 1.44 (1.1-1.9) 1.02 (0.6-1.7)
6087 General Poster Session (Board #7D), Mon, 1:15 PM-5:15 PM
Involvement of low- and middle-income countries (LMCs) in oncology
randomized controlled trials (RCTs). Presenting Author: Janice C. Wong,
Princess Margaret Hospital, Toronto, ON, Canada
Background: Lower costs and fewer regulatory barriers make clinical trials in
LMCs attractive, but little is known about characteristics of such trials and
roles of investigators from LMCs. We describe trends in participation of
investigators from LMCs in oncology RCTs over a decade. Methods: We used
Medline to identify all RCTs published in English between January 1 1998
and December 31 2008 evaluating treatment in five solid tumours (lung,
breast, colorectal, stomach, liver) with high mortality in LMCs as per
GLOBOCAN 2002. Data on author affiliations and roles (first, middle or
corresponding author), trial characteristics, funding and study interventions
were abstracted using an electronic form. Countries were stratified
into low-, middle- and high-income using World Bank data. Interventions
were categorized as requiring basic, limited, enhanced or maximal resources
as per the Breast Health Global Initiative classification. Logistic
regression identified factors associated with investigator participation from
LMCs. Results: 454 trials were identified: lung (n�177), breast (n�165),
colorectal (n�82), stomach (n�29), liver (n�7). The annual number of
trials published increased from 10 trials in 1998 to 86 in 2008. The
proportion of trials with at least one LMC author also increased over time
from 20% in 1998 to 29% in 2008 (p�0.01), but almost all LMC authors
were from middle-income countries. In 17% of trials involving LMC
authors, they were first or corresponding authors. 67% of trials involving
LMC investigators evaluated interventions requiring enhanced or maximal
resources for implementation. Factors associated with LMC participation
included industry funding (OR�3.57, p�0.0001), use of placebo arm
(OR�2.59, p�0.02) and metastatic setting (OR�3.87, p�0.0003).
Conclusions: An increasing number of oncology RCTs involve LMC investigators
primarily in non-leadership roles. These trials are commonly industryfunded
and often test interventions that require at least enhanced resources
for implementation. To minimize concerns of exploitation and facilitate
future collaboration it is crucial that interventions are locally feasible and
investigators receive appropriate authorship.
Health Services Research
403s
6086 General Poster Session (Board #7C), Mon, 1:15 PM-5:15 PM
The NCI Community Cancer Centers Program (NCCCP): A model for
reducing cancer health care disparities. Presenting Author: Donna M.
O’Brien, NCI NCCCP Program, Bethesda, MD
Background: In 2007, NCI launched the NCCCP, a public-private partnership
with 16 community hospital cancer centers in 14 states, to explore
methods to improve patient access to advanced cancer care in the
community. With 40% of its NCI funding directed to reduce disparities
across the cancer continuum, the NCCCP aims to: 1) Enhance access to
care; 2) Improve quality of care; and 3) Increase clinical trials accrual. This
approach supports priorities in the 2009 ASCO Policy Statement: Disparities
in Cancer Care. Methods: A disparities workplan was developed to
support the three aims. NCI and the sites worked as a learning collaborative
to develop strategies and metrics for: race and ethnicity data tracking; near
real-time reporting of adherence to Commission on Cancer (CoC) treatment
quality measures; community outreach and patient navigation to increase
cancer screening; and improved clinical trial underserved accrual. The
tools and resources supporting these efforts will be discussed.
(http://ncccp.cancer.gov/About/Progress.htm). Results: Evaluation of the 3
year pilot shows improvement for underserved populations: Concordance
with CoC treatment quality measures for radiation therapy for breast
conserving surgery among Medicaid patients improved from 59.5 percent
to 84.8 percent (p�.05). Increased community screening events (from
992 to 1,585) and community partnerships focused on underserved
populations (from 78 to 195). Increased accrual to NCI trials (minority
accrual from 82 to 151 and elderly from 200 to 641). Conclusions: To be
effective in reducing healthcare disparities, a multi-level approach is
needed. This includes having: organizations which demonstrate a strong
community-oriented mission; commitment by hospital management; engagement
of private practice physicians; targeted training of staff; use of
standardized data collection and metrics; involvement of strategic partners
with aligned goals at the national and local level; support by relevant NCI
experts; and sharing best practices across a learning collaborative. The
NCCCP disparities model was used in a variety of community settings
targeting different underserved populations and has demonstrated effect in
care in the respective communities.
6088 General Poster Session (Board #7E), Mon, 1:15 PM-5:15 PM
Beyond the performance rate: Understanding differences in treatment
status using the Rapid Quality Reporting System (RQRS). Presenting
Author: Erica J. McNamara, Commission on Cancer, American College of
Surgeons, Chicago, IL
Background: RQRS is a cancer registry based tool for rapid case ascertainment
and real-time care tracking using 5 National Quality Forum approved
quality measures for breast (BC) and colon cancer (CC) and 1 American
Society of Clinical Oncology, National Comprehensive Cancer Network and
Commission on Cancer (CoC) endorsed rectal cancer (RC) measure. RQRS
was introduced in 2009 for testing at selected CoC accredited programs.
The purpose of this study was to evaluate the proportion of cases with
treatment administered for 4 measures where care is concordant with
treatment either “administered” or “considered but not administered”
(CNA). Methods: Case information on 19,631 breast, colon and rectal
cancer patients diagnosed from 2009 – 2010 submitted by 64 RQRS
participating sites were reviewed for 4 measures: (1) hormone therapy
within 1 year of diagnosis (dx) for AJCC T1c, N0M0, or stage II or II;
hormone receptor positive BC (HT), (2) multi-agent chemotherapy within 4
months of dx; age � 70; hormone receptor negative BC (MAC), (3) adjuvant
chemotherapy within 4 months of dx; age �80; AJCC Stage III CC (ACT),
and (4) radiation therapy within 6 months of dx; age �80; AJCC T4N0M0
or stage III patients receiving surgical resection for RC (AdjRT). Treatment
status was defined as concordant (administered or CNA) or non-concordant
(NC – not part of planned first course therapy or received after required time
frame). Patient demographics and Charlson-Deyo (CD) co-morbidity scores
were compared by concordance status using Chi-square tests. Results: The
aggregate concordance rate was 83.3%. Among these 889 (5.4%) were
CNA. Co-morbidity score was � 0 for 15% of cases. Patients age � 70, with
Medicare insurance, CD score � 0 were significantly more likely to be CNA
compared to completed or NC. Patient choice was the most common reason
for CNA (64%). Conclusions: Among patients treated at RQRS test sites for
which RQRS measures applied and care was concordant, only 5% were
CNA. Patients over age 70 or with CD � 0 were more likely to have
treatment CNA. Inclusion of CNA as concordant care has a minor impact on
concordance rates and provides cancer programs with important information
for targeting care review and quality improvement programs.
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