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