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

408s Health Services Research
6106 General Poster Session (Board #9G), Mon, 1:15 PM-5:15 PM
Advanced gastrointestinal cancer patients’ perceptions of prognosis and
goals of treatment. Presenting Author: Areej Raed El-Jawahri, Massachusetts
General Hospital, Boston, MA
Background: Patients with advanced cancer require accurate perception of
their illness in order to make informed decisions regarding their care.
However, little is known about the accuracy of these patients’ illness and
prognostic understanding. The objectives of this study are to 1) examine
prognostic understanding in patients with advanced gastrointestinal (GI)
cancers, 2) assess patient preferences for prognostic information, and 3)
explore associations of perceptions with quality of life (QOL) and mood.
Methods: Cross-sectional study of 50 patients within 6-12 weeks post
diagnosis of advanced GI cancers (gastric, esophageal, pancreatic, and
hepatobiliary). We assessed patients’ perceptions of prognosis with a
15-item questionnaire, the Perception of Treatment and Prognosis Questionnaire.
QOL and mood were assessed using the Functional Assessment
of Cancer Therapy-General (FACT-G) and hospital anxiety and depression
scales (HADS), respectively. Results: We enrolled 50/62 (80%) consecutive
eligible patients within an 11-month period. 50% (25/50) of participants
responded that the primary goal of their cancer treatment was to “cure their
cancer.” Similarly, 54% (27/50) reported that they were “somewhat” to
“extremely likely” to be cured from their cancer. Only 22% (10/49)
reported having a discussion about their end-of-life care preferences with
their oncologist. 76% (38/50) reported wanting to know as many details as
possible about their cancer diagnosis and treatment and 64% (32/50)
rated this information as “extremely important.” Patients who perceived
knowing about their prognosis as “extremely helpful” reported a better QOL
(p � 0.009), lower symptoms of anxiety (p � 0.02) and depression (p �
0.02). Conclusions: Although the majority of patients report that they desire
detailed information about their prognosis, half incorrectly perceived their
cancer as curable and the majority did not discuss their end-of-life care
preferences with their oncologist. Patients who found learning about their
prognosis to be extremely helpful reported better QOL and mood. Studies of
interventions to increase advanced cancer patients’ knowledge of their
prognosis and to encourage end-of-life discussions are warranted.
6108 General Poster Session (Board #10A), Mon, 1:15 PM-5:15 PM
Assessing the clinical significance of real-time quality of life data in cancer
patients treated with radiation therapy. Presenting Author: Michele Y.
Halyard, Mayo Clinic, Scottsdale, AZ
Background: This pilot study evaluated whether providing clinicians with
patient(pt) QOL results and symptom management pathways linked to QOL
domains at the time of clinical appointment would result in improvement in
QOL and treatment (tx) satisfaction. The objective was to obtain preliminary
effect size estimates and logistical evidence for design of a larger,
definitive trial. Methods: Oncology pts receiving 5-7 weeks of radiotherapy
(RT) electronically completed QOL assessments (LASA) at baseline and
biweekly prior to seeing clinicians. Was It Worth It (WIWI) and Interpersonal
Patient-Provider Relationship (IPPRS) were measured at tx end. Pt endpoints
(pro-rated primary endpoint LASA area under the curve (AUC), LASA
changes from baseline, and WIWI responses) and clinician endpoints
(IPPRS) were compared between the control group (Phase 1: no QOL
feedback) and the intervention group (Phase 2: QOL feedback) via
Wilcoxon, Chi-square and Fisher Exact tests. There was 80% power to
detect a 10 point difference in average AUC. Results: 148 pts enrolled (79
Phase 1, 69 Phase 2) from 11/28/2008 to 09/20/2011 (sites GI (27%),
Lung (22%) and Head and Neck (52%)). 68% received RT and chemo.
There were consistently moderate effect sizes observed but no statistically
significant differences in any AUC nor end of tx change from baseline
scores. 20% fewer pts in phase 2 reported clinical deficits in overall QOL
(pain). In pts receiving 7 weeks of RT, end of tx average overall QOL, mental
well-being (WB), physical WB and pain severity were significantly better in
Phase 2 pts. WIWI results showed 76% found participation worthwhile,
95% would participate again, and 92% would recommend the study to
others. No differences between groups were found in communication
between clinicians and pts (IPPRS). Conclusions: Preliminary estimates
indicate potentially clinically significant improvements of moderate effect
size in mental and physical WB and pain severity when clinicians received
QOL real time with symptom management pathways. Further study is
warranted in larger trial setting.
6107 General Poster Session (Board #9H), Mon, 1:15 PM-5:15 PM
Association between baseline physical function and comorbidity status
with patient-reported quality of life after prostate cancer treatments:
Combined analysis of two prospective cohort studies. Presenting Author:
Ronald C. Chen, University of North Carolina at Chapel Hill, Chapel Hill, NC
Background: Treatment-related bowel, urinary, and sexual dysfunction in
prostate cancer patients varies by treatment type, baseline function and
other patient factors. To better predict patient outcomes after treatment,
we examined the impact of comorbidity on these quality of life (QOL)
outcomes in a secondary data analysis of two pooled, prospective cohort
studies. Methods: A total of 697 patients from 3 academic hospitals who
received radical prostatectomy, external beam radiation, or brachytherapy
were included. Using a validated instrument, patients reported bowel,
urinary, and sexual symptoms pretreatment, and at 3, 12, 24, and 36
months after treatment. Baseline physical function was measured by the
physical component summary score (PCS) of the SF-12 using patient
report. Comorbidity as measured by the Index of Co-Existent Disease
(ICED) was obtained from medical record review. Repeated QOL measurements
were analyzed using a mixed modeling method, by random coefficient
modeling. Separate models were built for each outcome using bowel,
urinary, and sexual scale scores at each time point.Covariates in all models
included baseline age, education, ICED, and PCS. Results: Approximately
70% of patients had one or more comorbid conditions at baseline. After
adjusting for age and education in mixed-models, we found baseline
comorbidity was independently associated with more sexual dysfunction
(p�.001) and urinary incontinence (p�.03). Worse baseline physical
functioning was independently associated with more bowel problems
(p�.001) and sexual dysfunction (p�.001). There were no treatment by
comorbidity or physical functioning interactions. Conclusions: Comorbidity
and worse physical functioning at baseline are significantly associated with
poorer bowel, urinary, and sexual function after treatment for prostate
cancer, but the associations do not appear to differ by treatment. Patients
with comorbidity recovered more slowly. This information may help patients
and their physicians anticipate outcomes after surgical and radiation
treatments.
6109 General Poster Session (Board #10B), Mon, 1:15 PM-5:15 PM
Changes in adjuvant breast cancer chemotherapy regimen selection over
time in the community. Presenting Author: Debra A. Patt, Texas Oncology,
US Oncology, Austin, TX
Background: Adjuvant breast cancer (BC) chemotherapy (CT) treatment has
evolved over time due to improved understanding of risk conveyed by
pathology and patient (pt) characteristics, as well as emergence of new and
mature data for survival and toxicity. We aimed to evaluate how CT regimen
selection has changed in recent years in various subgroups. Methods: Using
iKnowMed EHR data from The US Oncology Network, we retrospectively
identified female pts diagnosed with stage I-III BC between 1/2007 and
12/2010 at practices with EHR data available at time of diagnosis. Pts with
�5 office visits, those with a second primary or previous cancer diagnoses
were excluded. Age, ER, HER2, nodal status, stage and year of diagnosis
were captured. CT utilization was determined by the number of pts who
received CT within 6 months of their diagnosis. Clinical trial pts were
included. Regimens were categorized by the initial CT title and drugs
assigned. Pts with metastatic regimens were excluded. CT regimens were
analyzed by subgroups and trended over time. Results: During the time
period, 26,095 stage I-III BC pts were identified. A CT regimen within 6
months of diagnosis was documented in 56% of pts. CT utilization was
83% in HER2� pts, 85% in ER-/HER2- pts, and 45% in ER�/HER2- pts.
CT utilization decreased overall with increasing pt age (71%, 64%, 51%,
33%, and 13% for pts in their 4th ,5th ,6th ,7th and �8th decade of life). In
HER2� pts, use of non-anthracycline containing regimens increased from
26 to 62%, and anthracyline-taxane combination regimens decreased from
33 to 15%. In HER2-/ER� pts, the most used non-anthracycline regimen
was docetaxel � cyclophosphamide (TC) at 41%. Anthracycline-taxane
combinations were used more often in the HER2-/ER- group (32%).
Conclusions: In the 4 year study period, this data suggests that ER and
HER2 status may drive chemotherapy choice more than nodal status.
Anthracycline containing regimens are being used less often possibly due
to similar efficacy but less cardiac toxicity, particularly when combined
with trastuzumab. These results suggest a change away from anthracyclines
in specific subgroups with the controversy over the benefits of that
change unsettled, and cost implications yet unquantitated.
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