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

412s Health Services Research
6122 General Poster Session (Board #11G), Mon, 1:15 PM-5:15 PM
Variation in health-related quality of life (HRQOL) by ECOG performance
status (PS) and fatigue among patients with chronic lymphocytic leukemia
(CLL). Presenting Author: Christopher Flowers, Emory University, Atlanta,
GA
Background: Clinicians and investigators commonly use ECOG PS and
clinician-reported patient (pt) fatigue as surrogates for HRQOL, a multifaceted
construct that comprehensively looks at the pt perspective on
disease and well-being. Because limited data exist on the relationships
between PS, fatigue, and HRQOL for CLL pts, we examined the associations
between these measures, and 3 validated HRQOL instruments: the
Functional Assessment of Cancer Therapy-Leukemia (FACT-Leu), EQ-5D,
and Brief Fatigue Inventory (BFI). Methods: Data were collected in
CONNECT CLL, a prospective US observational registry initiated in 2010.
Patient demographics and clinical characteristics were provided by clinicians.
Patient HRQOL was self-reported at enrollment using the FACT-Leu,
EQ-5D, and BFI. Scores were analyzed by ECOG PS (0, 1, 2-4) and
clinician-reported fatigue (yes, no). Differences in HRQOL scores were
assessed by ANOVA. Results: HRQOL data were reported by 899 pts from
148 community, 10 academic, and 3 government centers. ECOG PS was
available on 711 pts. Overall HRQOL, measured by mean FACT-Leu,
FACT-G and EQ-5D Visual Analogue Scale (VAS), worsened with ECOG PS
severity and was worse in pts with fatigue (all p�0.0001). All FACT-Leu
domains except social/family were worse in pts with fatigue and those with
higher ECOG PS. Mean EQ-5D pain/discomfort, mobility, self care and
usual activities domain scores worsened in severity as ECOG worsened and
for pts with fatigue (all p�0.011). BFI data indicated that global fatigue,
fatigue severity and fatigue-related interference worsened by ECOG severity
and were associated with clinician-reported fatigue (all p�0.0001).
Conclusions: Initial CONNECT CLL results confirm that HRQOL worsens
with worsening ECOG PS and was worse among pts with fatigue, especially
in physical/functioning domains, pain/discomfort, and mobility. These
results indicate that baseline ECOG PS and physician-rated fatigue are
rapid assessments that predict robust measures of HRQOL. Future analyses
are planned to examine how HRQOL, ECOG PS and fatigue change over
time with changes in treatment and CLL disease status.
6124 General Poster Session (Board #12B), Mon, 1:15 PM-5:15 PM
Prevalence and predictors of adherence to antiemesis prophylaxis in lung
cancer: A population-based study. Presenting Author: Daniel Richard
Gomez, University of Texas M. D. Anderson Cancer Center, Houston, TX
Background: Nausea/vomiting is a significant toxicity in the treatment of
lung cancer, but barriers exist to the delivery of prophylaxis. We studied
compliance and predictors of prophylactic antiemetics with chemotherapy
in this setting. Methods: We used a Texas state registry of clinical data
linked with Medicare claims from 2001-2007. Our study population was
incident lung cancers treated with platinum agents within 12 months of
diagnosis. To define guideline-adherent care, we assessed compliance to
the American Society of Clinical Oncology recommended prophylactic
agents dexamethasone and a 5-HT3 antagonist. Adherence was scored as a
binary variable and defined as administration within 24 hours of the first
day of the first cycle of chemotherapy. We utilized a logistic regression
model to evaluate the role of the following factors in predicting adherence:
concurrent radiation therapy (RT), race (black vs. white), histology (small
cell vs. non-small cell), rural location, Charlson Comorbidity Index (CCI),
household income (by quartiles [Q]), education, and treatment year
(binary). Results: Of 31,762 patients in the database, 5155 patients met
the above criteria. The adherence rate to dexamethasone and 5-HT3
antagonists increased over time, from 51.5% in 2001 to 71.6% in 2007.
Patients treated in the years 2005-2007 were 1.739 times more likely to
be adherent to prophylaxis than were those from 2001-2004. Variables
that predicted adherence (adjusted odds ratio [OR], 95% confidence
interval [CI]) were: age (OR�1.013, CI [1.001, 1.026]), treatment year
(OR�1.756, CI [1.548, 1.991]), race (black vs. white OR�0.684, CI
[0.548,0.853]), median income (higher vs. lower OR�1.83 [Q2 vs. Q1];
OR�1.296 [Q3 vs. Q1]; OR�1.496 [Q4 vs. Q1]), CCI (1� vs. 0,
OR�0.613, CI [0.530,0.709]), and concurrent RT [yes vs. no OR�1.358,
CI [1.197,1.541]). Conclusions: Compliance with guidelines for prophylactic
antiemetics is suboptimal, but increasing over time. Several characteristics
predict for improved adherence, including white race, median income,
advanced age, and the receipt of concurrent RT. These findings highlight
substantial economic disparities in supportive care of lung cancer in the
state of Texas.
6123 General Poster Session (Board #12A), Mon, 1:15 PM-5:15 PM
Loss to follow-up of cancer patients in the poorest district of the United
States. Presenting Author: Antranik Mangardich, Lincoln Medical and
Mental Health Center, Bronx, NY
Background: Loss to follow-up (LFU) of cancer patients is a serious
dilemma, and has only been narrowly studied. Lincoln Medical and Mental
Health Center (LMMHC) serves South Bronx (SB), the poorest district in the
nation. The purpose of this study was to assess rates of LFU and correlate it
with age, sex, ethnicity, race, cancer types, and stage at diagnosis.
Methods: We collected data from 1,552 patients diagnosed with invasive
cancer in LMMHC between 2006-2010. The data collected were age, sex,
ethnicity, race, type of cancer, stage, LFU, treatment, and vital status.
Results: From the 1,552 patients, roughly 25 % were LFU, with 50%
receiving some initial form of treatment. The remaining percentages are
shown below (Table). A higher rate of LFU was with patients younger than
65 (OR: 1.38, 95% CI: 1.08-1.76). There was no correlation between sex
and LFU. Non-Hispanics were more likely to be LFU compared to Hispanics
(OR: 1.39, 95% CI: 1.07 – 1.8). Blacks were more likely to be LFU
compared to non-Blacks (OR: 1.43, 95% CI: 1.12–1.82). There was no
significance between LFU and stage at diagnosis. Looking at cancer
specific data, colon cancer (C) and head and neck cancers (HN) had the
highest percentage of LFU (30% each). There was higher LFU rate for C
compared to breast cancer (B) (OR: 1.7, 95% CI: 1.03-2.8), prostate
cancer (P) (OR: 1.88, 95% CI: 1.18-3.02), and lung cancer (L) (OR: 1.64
95% CI: 0.94- 2.8). HN patients were more likely LFU compared to B (OR:
2.4, 95% CI: 1.13-5.2), P (OR: 2.69, 95 % CI: 1.28-5.68), and L (OR:
2.3, 95% CI: 1.05-5.19) patients. There was no significant difference
between C and HN patients in respect to LFU. Conclusions: In the SB, LFU
rates are related to age, ethnicity, race, and type of cancer. Younger
patients, blacks, non-Hispanics, and those with C and HN cancers were
most likely to be LFU, the latter likely due to the lack of a HN surgeon at
LMMHC. We hope that with focus on race, ethnicity, and cancer-specific
disparities in LFU rates, we will improve the retention rate of our cancer
patients in the future.
Continued to
Sent to nursing
Transferred
LFU
follow up
home/hospice
to other facility
371 (24%) 863 (55%) 167 (11%) 151 (10%)
No Rx Rx No Rx Rx No Rx Rx No Rx Rx
190 (51%)
Rx�treatment
180 (49%) 190 (22%) 672 (78%) 105 (63%) 67 (37%) 93 (62%) 58 (38%)
6125 General Poster Session (Board #12C), Mon, 1:15 PM-5:15 PM
In-hospital mortality of patients admitted through the emergency department
of a comprehensive cancer center. Presenting Author: Ahmed F.
Elsayem, University of Texas M. D. Anderson Cancer Center, Houston, TX
Background: Cancer is a common presenting condition for emergency
departments (EDs); however, there is limited information on outcomes of
ED cancer patients subsequently admitted to the hospital. The purpose of
this study is to describe outcomes of patients with hematologic malignancies
versus those with solid tumors admitted through the ED of a
comprehensive cancer center. Methods: We queried the ED database of The
University of Texas MD Anderson Cancer Center for calendar year 2010 and
linked it to our institutional data warehouse, including tumor registry data.
We classified all leukemia and related disorders, lymphoma, multiple
myeloma, and bone marrow transplant patients as hematologic malignancies,
and remaining cancers as solid tumors. Descriptive statistics, including
chi-square, and t-tests were used in two-sided comparisons. All
statistical analyses were performed using SPSS version 15. Results:
20,732 total ED visits were made by 9,320 unique cancer patients. Of
these, 5,364 (58%) were admitted to the hospital at least once (range 1-13
admits). ED admissions constituted 39% of total unique patients admitted
(N�13,753). The main admission indications for solid tumor patients were
infectious complications (particularly pneumonia), intractable pain, or
dehydration. For hematologic malignancies, the main indication was
neutropenic fever. 211/1656 (13%) of liquid tumor patients were admitted
to the Intensive Care Unit (ICU) compared to 484/3708 (13%) of solid
tumor patients (P�NS). Of all patients admitted through the ED, 587/
5364 (10.9%) died during hospitalization. The hematologic hospital
mortality rate was 225/1653 (13.6%) versus 362/3708 (9.8%) for solid
tumors (P�0.001). Only 242/8389 (3%) of patients admitted directly
from outpatient clinics died during the hospitalization (p�0.001).
Conclusions: Patients admitted through the ED, particularly those with
hematologic malignancies, have a high hospital mortality rate. ED-based
palliative care interventions may be justified to improve quality of life and
prevent unnecessary costly interventions and ICU admission. Further
research should define predictors of poor outcomes in cancer patients
admitted through the ED.
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