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

414s Health Services Research
6130 General Poster Session (Board #12H), Mon, 1:15 PM-5:15 PM
Multidisciplinary assessment and reporting of fitness to drive in brain tumor
patients: A gray matter. Presenting Author: Alexander V. Louie, London
Regional Cancer Program, London, ON, Canada
Background: In some jurisdictions, there is a legal requirement for physicians
to report medically unfit drivers. Objectives of this study are to
determine physician knowledge and attitudes on reporting legislation and
driving assessment, and review our institution’s experience in evaluating
fitness to drive in brain tumour patients. Methods: Physicians caring for
brain tumour patients in South-western Ontario were identified by public
databases and surveyed by mail. Survey questions elicited demographics,
opinions, and factors influencing the decision to report. Patients receiving
brain radiotherapy at our institution between January and June 2009 were
identified and details of driving assessment were extracted. Fisher’s exact
test and a logistic regression model were used to determine differences in
responses between specialists and family physicians and factors influencing
reporting. Results: Surveys (n�467) were distributed with 198 (43%)
responses. Most (76%) felt that reporting guidelines were unclear. Neurologists
(43%) and Family Physicians (22%) were felt to be the most
responsible to report unfit drivers. Compared to specialists, Family Physicians
were less likely: to be comfortable with reporting (p�0.02), to
consider reporting (p�0.001), or discuss the implications of driving
(p�0.001). Perceived barriers in assessing fitness to drive included: lack
of tools to assess (57%) and the impact on the patient-physician relationship
(34%). 158 patients were retrospectively reviewed. Forty-eight patients
(30%) were reported to the provincial licensing authority and 64
(41%) were advised not to drive. 53 patients experienced seizures, of
which 36 (68%) had a documented discussion on driving. Only 30 (56%)
of these patients were reported to the licensing authority despite legal
requirements. Age, primary disease, previous neurosurgery and seizures
were predictive of reporting (p�0.05). On logistic regression modeling,
seizures (OR 12.4) and primary CNS disease (OR 15.5) remained predictive
of reporting. Conclusions: Despite guidelines and laws, the assessment
of fitness to drive in patients with brain tumours is not routinely conducted
or documented in a multidisciplinary setting.
6132 General Poster Session (Board #13B), Mon, 1:15 PM-5:15 PM
Predictors of retention in a cervical cancer survivorship study. Presenting
Author: Lari B. Wenzel, University of California, Irvine, Irvine, CA
Background: Women with cervical cancer experience numerous quality of
life (QOL) disruptions. A completed pilot study indicated that QOL and key
biomarkers could be improved with psychosocial telephone counseling
(PTC). A confirmatory trial has recently completed accrual.The purpose of
this study is to identify predictors of retention in this large biobehavioral
trial, and examine retention differences between the pilot and confirmatory
trial. Methods: Women with stage I – III cervical cancer diagnosed 9–30
months earlier were randomized to either PTC or usual care. PROs and
biological specimens were collected prior to randomization (N�204), and
3 (T2) and 9 months post baseline. Sociodemographic, clinical and QOL
variables were evaluated from baseline to T2 to identify predictors of study
retention. Multiple measures, including the PROMIS Depression and
Anxiety scales were entered into a multivariate stepwise logistic regression
model to predict study retention. Results: In the multivariate model, being
randomized to counseling (OR�4.4, 95% CI: 1.5-12.6), having clinically
significant depression, defined as �1 SD above the 50th percentile
(OR�4.2, 95% CI:1.7-10.5) and being single (OR�3.4, 95% CI: 1.3-9.2)
were the most significant predictors of drop-out in the study overall. Among
those in the counseling arm, depression is the strongest predictor of
dropout, with a five times higher dropout rate (OR�5.2, 95% CI:1.9-15.6)
than those with low to moderate levels of depression, or no depression.
However, retention rates improved substantially overall from the pilot study
(72%) to the confirmatory study (84%), in both study arms, and retention
increased among Latinas from 60% in the pilot study to 83% in the current
study, and from 52% to 81% among those with less than a high school
education. Conclusions: Results from this analysis of predictors of retention
indicate that enhanced attention to sociocultural disparities can improve
study retention. Attending to baseline clinical depression may be a further
consideration.
6131 General Poster Session (Board #13A), Mon, 1:15 PM-5:15 PM
Sociodemographic and patient disparities in use of first-line chemotherapy
(CT) in older adult patients (pts) with advanced non-small cell lung cancer
(AdvNSCLC): Analysis of Surveillance, Epidemiology, and End Results
(SEER)-Medicare data. Presenting Author: Josephine Feliciano, University
of Maryland Greenebaum Cancer Center, Baltimore, MD
Background: Clinical trials have demonstrated that CT improves survival
and quality of life in pts with AdvNSCLC. Our prior studies suggest that only
26% of older pts diagnosed with AdvNSCLC received CT through 2002. In
this study, we examined more recent patterns, and the effect of sociodemographics,
race, and age on receipt of CT in older pts with AdvNSCLC.
Methods: Medicare pts diagnosed with AdvNSCLC from 2001-2005 were
identified in SEER registries. Medicare enrollment data provided demographic
information (age, race, sex, marital status), augmented with census
tract level data on median household income. Comorbid conditions at
baseline were identified by ICD9-CM diagnoses on claims. Receipt of 1st
line CT was identified based on agent-specific procedure codes in claims.
Logistic regression examined predictors of 1st line CT. Results: Of 31,341
pts with Adv NSCLC, 34% received 1st line CT. As reflected in the table,
poor predicted PS (PredPS), multiple medical comorbidities, and black
race were associated with lower likelihood of CT receipt. Being female,
married, having higher income, and being diagnosed at a later year were
associated with a higher likelihood of receiving CT. Conclusions: Even when
controlling for factors such as PS, our results suggest the presence of age,
race, and socio-economic disparities in the receipt of 1st line CT for older
patients with AdvNSCLC.
Multivariate association of pt characteristics with receipt of 1st line CT.
Covariate Odds ratio 95% CI
Dx age (yrs)
--
--
70-74
0.81
0.76, 0.88
75-79
0.57
0.53, 0.61
80-84
0.33
0.30, 0.35
>85
0.13
0.11, 0.15
Race
--
--
Non-Hispanic Black
0.83
0.76, 0.92
Prior year Medicaid or MSP 0.86 0.79, 0.94
Female 1.09 1.03, 1.15
Married 1.54 1.46, 1.63
Dx Yr
--
--
2002
1.12
1.04, 1.22
2003
1.25
1.15, 1.35
2004
1.27
1.17, 1.38
2005
1.32
1.22, 1.43
6133 General Poster Session (Board #13C), Mon, 1:15 PM-5:15 PM
Patient satisfaction with participation in phase II/III NCCTG clinical trials:
Was it worth it? (N0392). Presenting Author: Cynthia Chauhan, North
Central Cancer Treatment Group, Wichita, KS
Background: Patient (pt) trial experience may give insight to quality of life
(QOL) factors affecting accrual, retention and outcome. While pts are vital
to clinical trial success, we know little about their post-trial opinions. This
trial examined pt opinion of their trial and treatment decision making
(TDM). Methods: Pts enrolled on designated North Central Cancer Treatment
Group (NCCTG) phase II or III treatment trials completed the TDM
Control Preferences Scale at baseline and the Was It Worth It (WIWI)
satisfaction assessment at the ends of cycle 1 and active protocol
treatment. The primary endpoint was the proportion of pts reporting
worthwhile participation. Fisher Exact tests compared pt opinion across
subgroups. Results: As of 01/15/2012, 264 pts were enrolled on 25
protocols and treated at 79 sites. 86% of pts were in phase II studies and
89% had stage IV disease. At the end of cycle 1, pts felt the trial was
worthwhile (74%), would do it again (85%), and would recommend it to
others (82%). 85% of pts reported undiminished QOL and only 7% rated
the trial worse than expected. End of treatment responses were similar.
Satisfaction rates varied by tumor site (p�0.04). 11% of pts having tumor
response rated the trial as not worthwhile, and 66% of pts with progressive
disease rated it worthwhile (see table). Pts with concordant preferred and
actual TDM roles rated participation higher than pts with discordant TDM
roles (see table). Conclusions: Most pts endorsed their clinical trial
experience. Contrary to popular beliefs, treatment outcome did not have an
overwhelming impact on pt satisfaction, and was just one of many factors
such as TDM role discordance. Assessing pt satisfaction will inform future
study design that can potentially improve pt accrual and retention.
Answered yes to. ..
Response by end of Tx WIWI scores CPS by 1-month WIWI scores
CR/PR PD SD P value
Concordant
(N�230)
Discordant
(N�28) P value
Worth it? 89% 66% 82% 0.01 75% 64% 0.13
Do again? 92% 93% 81% 0.07 87% 68% 0.01
QOL maintained? 83% 71% 84% 0.01 85% 75% 0.38
Study expectations
met or better?
92% 81% 85% �0.01 94% 86% 0.11
Recommend? 91% 90% 80% 0.15 83% 68% 0.04
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