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

576s Patient and Survivor Care
9036 Poster Discussion Session (Board #21), Mon, 1:15 PM-5:15 PM and
4:45 PM-5:45 PM
Patient information desire in actual decision making for advanced cancer
treatment: Do doctors know their patients? Presenting Author: Linda J. M.
Oostendorp, Radboud University Nijmegen Medical Center, Nijmegen,
Netherlands
Background: Providing information is an important element of cancer care.
While several studies have investigated patients’ information desire, to our
knowledge, this study is the first to involve patients facing an actual
decision. We examined the information desire of patients at the point of
decision making, the ability of doctors to judge this desire, and the
information provided by the doctor. Methods: This prospective multicenter
study included patients with advanced colorectal or breast cancer faced
with the decision whether or not to pursue second-line chemotherapy.
Patients received the usual treatment-related information from the doctor
plus a decision aid from a nurse. The aid contained information on adverse
events, tumor response, and survival. For each item, the nurse asked the
patient whether the information was desired and whether it had been
disclosed by the doctor and the doctor made a substitute judgment of the
patient’s information desire on the inclusion form. The match between
patient’s desire and doctor’s judgment was expressed in percentage
agreement and agreement corrected for chance (�). Results: By 01/2012,
71 patients had received the decision aid. Median age was 62 years (range
39-80), 38% were male, and 28% had college education or higher.
Information on adverse events, tumor response, and survival was desired by
94%, 90%, and 73% of patients. The doctors judged that information
desire would be 100%, 97%, and 81%, respectively. There was a poor
match between doctor’s judgment and actual information desire for
adverse events (94%, � not applicable), tumor response (87%, � �
-0.049), and survival (61%, � � -0.104). When asked whether the
information was previously disclosed by the doctor, 73%, 57%, and 30% of
patients answered affirmatively. Conclusions: Patients expressed a high
information desire, which was accurately judged by the doctors. However,
doctors were unable to judge an individual patient’s information desire
beyond chance. According to the patients, doctors did not disclose all
desired information, especially on survival. Decision aids, similar to those
used here, have been shown to help doctors provide safe, effective, and
timely information to patients.
9038 General Poster Session (Board #38A), Sat, 8:00 AM-12:00 PM
Difficult conversations with terminal patients: Palliative care and death at
home. Presenting Author: Eduardo L. Morgenfeld, Instituto Oncológico
Henry Moore, Buenos Aires, Argentina
Background: More than half the total number of oncological patients may
die due to the disease’s progression, and at some point in time the
oncologist must communicate that the disease is terminal. This is the
hardest conversation (HC) of a clinical oncologist. The following paper’s
objective is to determine whether or not the treatments applied to patients,
and their evolution, are affected by having had the HC. Methods: All
patients who died due to progression of the disease in 2011 were selected
for this study. Both medical histories and applied treatments were
evaluated. All doctors were interviewed to establish when the HC had taken
place. The distribution of variables was analyzed and both populations
compared. Results: Between January 2011 and December 2011, 110
patients who met the previous criteria were studied. Population characteristics:
Sex (Female: 52 pts; Male: 58 pts). Median age at the time of death:
61 years (Range: 27-88). Patients were divided in two groups: A (terminal
status of the disease had been discussed; 70 pts) and B (terminal status of
the disease had not been discussed; 40 pts). Both groups were similar in
diagnosis, age and previous treatments. During the post HC evolution, three
elements were categorized according to the table below. Conclusions: 1–
The conviction, ethical sense and strength of will of the doctor are
determining factors when related to his or her capacity to talk with the
patient about the terminal aspect of the disease. 2 – The chemotherapy
treatments applied during the last two months of life are similar in both
groups. 3 – The percentage of patients that died at their homes under
palliative care was remarkably higher amongst those who had been
informed than those who had not been informed.
Group A
N�70 (%)
Group B
N�40 (%) p value
Condition
Recieved chemotherapy in the
two months prior to death
24 (34%) 17 (42%) 0.391
Received palliative care 55 (79% 15 (37%) 0.0001
Died at home 44 (63%) 6 (15%) 0.0001
9037 Poster Discussion Session (Board #22), Mon, 1:15 PM-5:15 PM and
4:45 PM-5:45 PM
Women know, and men wish they knew, prognostic information in advanced
cancer. Presenting Author: Kalen M. Fletcher, Dana-Farber Cancer Institute,
Boston, MA
Background: Little is known about gender differences in advanced cancer
patient communication with oncologists. The few studies conducted have
explored differences in preferences for prognostic disclosure. Our data
allow us to test for gender differences in actual rates of audio-recorded,
patient and oncologist reported, prognostic disclosures. We studied a group
of advanced cancer patients to determine whether gender disparities exist
in: a.) reported rates of prognostic disclosures from physicians and b.)
willingness to estimate (versus not) one’s prognosis (i.e., amount of time
left to live). Among patients who report never receiving a prognosis from
their physician, we also tested for gender difference in wishing that this had
been discussed. Methods: Coping with Cancer II is an NCI -funded
multi-site, prospective longitudinal study of advanced cancer patients.
Patients were interviewed after receiving scan results and asked if they
have received a prognosis from their oncologist either at their most recent
visit or at any time in the course of their disease. They are also asked if they
would be willing to estimate their prognosis. Patients who state that they
have not received a prognosis are asked if they wish that they had. Results:
Among the advanced cancer patients studied (N�51; men�23,
women�28), male cancer patients were significantly more likely to state
never receiving a prognosis from their physician than female patients
(OR�3.5; �2�4.49, df�1, p�0.034). Male cancer patients were also
significantly less willing to provide a life-expectancy estimate (OR�5.6;
�2�5.06, df�1, p�0.025). Among patients who stated never receiving a
prognosis (N�27; men�16, women�11), male patients tended to be more
likely than female patients to wish that their prognosis had been discussed
(OR�7.8; �2�3.11, df�1, p�0.078). Conclusions: Male advanced cancer
patients are less likely than female cancer patients to state that they have
received prognostic information and less willing to provide a lifeexpectancy
estimate. Although male patients receive less open prognostic
disclosure than female patients, male patients tend to be more likely than
female patients to want prognostic information.
9039 General Poster Session (Board #38B), Sat, 8:00 AM-12:00 PM
In-hospital cancer care: Are we missing an opportunity for end of life care?
Presenting Author: Gabrielle Betty Rocque, University of Wisconsin Carbone
Cancer Center, Madison, WI
Background: Little data exists on the estimated survival of patients with
metastatic cancer after hospitalization. As part of a prospective quality
improvement project, we characterized the population of patients admitted
to an inpatient oncology service in an academic medical center with
emphasis on the disposition at discharge and overall survival. Methods: We
collected data over a 4 month period (9/1/10-12/23/10) representing 149
admissions of 119 unique patients. We measured patient characteristics,
disease evaluation, procedures, consults, imaging studies performed,
disposition, length of stay, and overall survival. These data were compared
to a similar study conducted in our center in 2000. Results: Uncontrolled
symptoms were the most common reason for admission (pain 28%,
dyspnea 9%, nausea 9%). Imaging studies were more common than in
2000 (415 vs. 196 total procedures). Eighty-five percent of patients had
progressive disease. Seventy percent of patients were discharged home
without additional services such as home health or hospice. The overall
median survival was poor in 2000 and in 2010, 100 days and 60 days from
discharge, respectively. Despite an overall poor prognosis, palliative care
consultation was obtained only 13 times (8% of admissions) and 18% of
patients were enrolled in hospice at discharge. Conclusions: An unscheduled
hospital admission portends a poor prognosis. Cancer patients in the
hospital are nearing the end-of-life with a median life expectancy of
approximately 3 months and could be considered hospice-eligible and
appropriate for a palliative care consult. We believe that hospital admission
represents a missed opportunity to provide palliative care services and
end-of-life counseling to this patient population.
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