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

6134 General Poster Session (Board #13D), Mon, 1:15 PM-5:15 PM
Relationship of MRI tests and referral of malignant adnexal masses to
gynecologic oncologists for surgery. Presenting Author: Rachel Kupets,
Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON,
Canada
Background: To evaluate the patterns of radiologic imaging by family
physicians and gynecologists in the work up of women found to have an
adnexal mass on pelvic ultrasound. To evaluate whether advanced imaging
tests are associated with improved referral of high risk adnexal masses to
gynecologic oncologists. Methods: Centralized provincial databases of
healthcare utilization were used to identify women aged 45 and older who
received a pelvic ultrasound between 2006-2008. Subsequent imaging
tests ordered by physician specialty were identified. Of those women who
proceeded to laparotomy, logistic regression was performed to determine
which imaging tests were associated with referral of high risk adnexal
tumors to a gynecologic oncologist. Results: 193, 261 women had a pelvic
ultrasound; 19, 949 (10.3%) had a laparotomy. 2223 and 627 women
were categorized with benign and malignant adnexal masses respectively.
Up to 12% of women had a pelvic MRI and 58% of women had a CT scan
after a pelvic ultrasound.Family physicians referred 58% and gynecologists
referred 47% of high risk ovarian masses to a gynecologic oncologist
respectively after imaging.Gynecologic Oncologists operated on only 55%
of women with malignant adnexal masses. On multivariate analysis factors
significant for surgery by a gynecologic oncologist include a preoperative CT
Scan OR 3.58 (p�.001) and CT Scan and MRI OR 7.78 (p�.001).
Preoperative MRI alone had an OR of 1.86 (p�0.09) and was not
significant. Mean time to surgery significantly increased when further
imaging tests were performed after a pelvic ultrasound (100 days), CT (131
days), MRI (170 days), CT and MRI (179 days),P 0.002. Conclusions: The
addition of a pelvic MRI to a pelvic ultrasound does not improve the referral
of high risk adnexal masses to a gynecologic oncologist. A consensus on
appropriate imaging and triage is needed when an adnexal mass is
identified on ultrasound.
6136 General Poster Session (Board #13F), Mon, 1:15 PM-5:15 PM
Relationship between whole-body tumor burden and quality of life in
patients with neurofibromatosis. Presenting Author: Scott Randall Plotkin,
Massachusetts General Hospital Cancer Center, Boston, MA
Background: NF1, NF2, and schwannomatosis are a group of related
genetic disorders in which affected individuals share the predisposition to
develop multiple nerve sheath tumors. While previous studies have investigated
the relationship between cutaneous tumor burden and quality of life,
the relation between internal tumors and quality of life is unknown.
Methods: As part of an IRB-approved research study, we performed
whole-body MRI and administered the short form (SF)-36 to 245 adult
subjects with NF. The number and location of internal nerve sheath tumors
in each patient was identified by a board-certified radiologist and tumor
volume was calculated using semi-automated volumetric analysis. One
sample t-tests were used to compare subjects’ SF-36 scores to general
population means. Independent linear regression analyses controlling for
age and gender effects were used to relate whole-body tumor count,
volume, and distribution (via Gini coefficient) to each domain of the SF-36.
Results: 245 patients (142 with NF1, 53 with NF2, 50 with schwannomatosis)
completed the study. On the SF-36, subjects with NF1 showed
reduced quality of life in the physical role, emotional role, and mental
health domains compared to the normal population (p�0.05). Subjects
with NF2 showed reductions in the physical functioning, physical role,
general health, and social functioning domains while subjects with schwannomatosis
showed reductions in the physical role and bodily pain domains
(p�0.05). In linear regression analysis, increased tumor number, increased
tumor volume, and decreased Gini coefficient were correlated with
decreased physical functioning in patients with NF2 (p�0.01). There was
also a trend for increasing tumor volume to be correlated with decreased
physical role and increased bodily pain in patients with NF1 and with
increased bodily pain in patients with schwannomatosis (p�0.10).
Conclusions: In our multi-institutional cohort, patients with all forms of
neurofibromatosis show selected deficits in quality of life. Internal tumor
burden does not correlate with these deficits, with the exception of physical
function in NF2 patients.
Health Services Research
415s
6135 General Poster Session (Board #13E), Mon, 1:15 PM-5:15 PM
Patient-reported toxicity after treatment for cancers of the head and neck.
Presenting Author: Christine E. Hill-Kayser, Hospital of the University of
Pennsylvania, Philadelphia, PA
Background: Patients with cancers of the head and neck (HNC) may be at
risk for significant late effects after treatment. Quality of life may be altered
significantly as a result. This Internet based study evaluates patient
perceptions of toxicity after treatment for HNC. Methods: Patient-reported
data were gathered via a convenience sample frame from HNC survivors
voluntarily utilizing a publically available, free, Internet-based tool for
creation of survivorship care plans. Available at www.livestrongcareplan.com
and through the OncoLinkwebsite, the tool allows survivors to enter data
regarding diagnosis, demographics, and treatments, and provides customized
guidelines for future care. During use of the tool, HNC survivors are
queried regarding late effects associated with specific treatments. All data
have been maintained with IRB approval. Results: Of 3866 survivors using
this tool between 4/2010 and 10/2011, 140 (4%) had undergone primary
treatment for HNC. Median diagnosis age was 52y and median current age
56y. When queried regarding treatment received, 88% reported having
undergone radiation, 73% surgery, and 67% chemotherapy. Many patientreported
late effects were associated with local tumor control, and included
difficulty swallowing/speaking (83%), decreased saliva production (88%),
dental problems (49%), thyroid problems (33%), decreased neck mobility
(60%), eye and vision deficits (9%), and tinnitus (40%). In addition, 53%
noted concerns regarding cognitive function. Users of the tool reported that
they would share it with their healthcare team in 55% of cases. The most
common reasons for not sharing it were “I did not think they would care,”
and “ I did not want to upset or anger them.” Conclusions: Survivors using
this tool anonymously and voluntarily report significant toxicity after
treatment for HNC. Not all survivors appear comfortable discussing these
issues with healthcare providers, despite major potential impact on quality
of life. The data reported here may be of significant impact in future study
of outcomes after HNC, as well as patient counseling and survivor care.
6137 General Poster Session (Board #13G), Mon, 1:15 PM-5:15 PM
Predictive factors on the receipt and completion of adjuvant chemotherapy
in a mixed sociodemographic cohort of patients. Presenting Author: Blase
N. Polite, The University of Chicago , Chicago, IL
Background: African Americans are more likely to die from breast, colon and
lung cancer compared to whites. They are also less likely to receive and
complete recommended therapy. The reasons for this are unknown.
Methods: Breast, colon, and lung cancer patients eligible for adjuvant
chemotherapy (stage IB-III breast, stage IIB-III colon, and Stage IB, II
lung) and who received surgery at 2 urban medical centers, were approached
between 2008 and 2010 and completed a self-administered
survey focusing on sociodemographic factors, including social support,
anxiety, depression, co-morbidities, trust and God Locus of Control (e.g.,
Whatever happens to my cancer is God’s will). These variables were related
to receipt and completion of chemotherapy. 191 patients were approached,
161 consented and 30 refused (16%); out of the 161, 23 were
deemed ineligible because of previous cancers, non-curative stage or
receipt of chemotherapy in the neoadjuvant setting. Results: Final sample
consisted of 138 pts. Median age: 54; sex:81% F; Race/Ethnicity:47% AA,
38% white, 9% Hispanic, 6% Asian/PI; Cancer Type: 73% Breast, 21%
Colon, 6% Lung. Compared to whites, AA were more likely to have
incomes�20K (35% vs. 10%, p�.0002), have any comorbidities (80% vs.
57%, p�0.006), and have high levels of God Locus of Control (56% vs
27%, p�0.003). There were no differences by race in chemotherapy
receipt (89% vs. 88%) or relative dose intensity (RDI) of chemo��85%
(58% vs. 67%). No factor in our model predicted chemotherapy receipt or
RDI at a significant level. Pts with high God Locus of Control were
somewhat more likely to start chemotherapy (OR 1.7, p�0.25) but were
less likely to complete therapy (OR 0.55, p�0.19). The magnitude of these
relationships held after controlling for age, race, comorbidities, cancer
type, functional status, and social support. Conclusions: In a mixed
sociodemographic cohort of patients, receipt and completion of adjuvant
chemotherapy was similar by measured sociodemographic variables. Only
high God Locus of Control was suggestive of being less likely to complete
chemotherapy. Further attention and research on the role of religious
beliefs in the cancer decision making process is warranted.
Visit abstract.asco.org and search by abstract for the full list of abstract authors and their disclosure information.