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

9040 General Poster Session (Board #38C), Sat, 8:00 AM-12:00 PM
Palliative cancer therapy during end of life at a regional cancer center in
Norway in 2005 and 2009. Presenting Author: Mari Aas Gynnild, Department
of Cancer Research and Molecular Medicine, Norwegian University of
Science and Technology and The Cancer Clinic, St. Olavs Hospital,
Trondheim University Hospital, Trondheim, Norway
Background: With increasing number of available therapies, there is a risk
that patients (pts) are overtreated. Palliative cancer therapy is mostly
recommended for pts with good Performance Status (PS). In one study, 42
% of pts received chemotherapy (CTx) during the last 30 days of life –
suggesting that this may not always be the case. Methods: All pts who,
according to the national registry, died from cancer in our region in 2005
and 2009 were analyzed. Data were collected from individual medical
records. Endpoints: Time from the end of palliative cancer therapy until
death. Whether there were differences depending on age; type of cancer;
year of death or if they were seen at a palliative care unit (PCU). PS when
the last cancer therapy was initiated. Results: 616 pts died in 2005; 599 in
2009. We excluded 495 pts: No cancer therapy (n�260); no information
of cancer (n�101); last therapy with curative intention (n�83); hematological
malignancy (n�51). Median age 71 (6 - 99); 49 % men; median overall
survival from diagnosis: 16.9 mos. Last therapy was radiotherapy (RT): 31
%; CTx: 40 %; hormonal: 15 %; surgery: 11 %. 4 % died from treatment
complications. Median time from start of last CTx or RT until death: 100
days; from end of last CTx or RT: 63 days. Younger pts received more CTx
and RT in the last 30 days: Age � 60: 28 %; 60-70: 23 % and 70�:12%
(p�.001). The table shows the use of CTx and RT the last 30 and 14 days
for the most common cancers. Among those who got CTx in the last 30 days
(n�74); 54 % had PS 2; 14 % PS 3-4. Among those who got RT in the last
30 days (n�61), 31 % had PS 2; 54 % PS 3-4. Of the 49 % referred to the
PCU, fewer received CTx or RT in the last 30 days (PCU: 14 %, no PCU: 22
%; p�.002) and 14 days (PCU: 5 %, no PCU: 12 %; p�.001). Conclusions:
Many pts received cancer therapy the last month of life. The percentage
varies with age, cancer type and was lower in 2009 than in 2005. Pts seen
at the PCU received less CTx and RT. Many pts had a poorer PS at the start
of last cancer therapy than recommended.
(n in 2005/2009)
Lung
(n�74/81)
Colon
(n�57/52)
Breast
(n�34/33)
Prostate
(n�45/46)
All
(n�352/369)
CTx last 30 d 19%/20% 4%/10% 18%/6% 0%/0% 11%/10%
CTx last 14 d 12%/4% 0%/4% 12%/3% 0%/0% 6%/3%
RT last 30 d 22%/11% 11%/4% 9%/6% 0%/11% 10%/7%
RT last 14 d 12%/6% 5%/0% 6%/3% 0%/7% 5%/3%
9042 General Poster Session (Board #38E), Sat, 8:00 AM-12:00 PM
Feasibility and acceptability of patient-reported outcomes data collection
for clinical care following breast reconstruction. Presenting Author: Andrea
Pusic, Memorial Sloan-Kettering Cancer Center, New York, NY
Background: To date, systematic measurement of patient-reported outcomes
(PROs) has played an important role in cancer research, but not in
routine clinical care. Our objective was to evaluate the feasibility of
developing and piloting an electronic PRO data collection in clinical care
among breast reconstruction patients using the BREAST-Q, a previously
developed condition-specific PRO measure for breast surgery patients that
measures quality of life (e.g. psychosocial, physical and sexual well-being)
as well as patient satisfaction (e.g. satisfaction with breasts, with information,
with surgeon). Methods: The BREAST-Q was loaded to the MSKCC
WebCore, a generic electronic patient-reporting platform adhering to strict
privacy and security standards. Patients attending visits at the MSKCC
Breast Reconstruction Clinic were asked to complete the BREAST-Q
electronically prior to scheduled visits. For patients with email addresses, a
reminder with web-link to the questionnaire was emailed automatically
prior to the visit. Results: Over a 9 month start-up period, BREAST-Q
surveys were completed by 1442 patients. Patients completed the questionnaire
at set time points before and after surgery. A total of 2340 BREAST-Q
surveys were completed overall. Mean completion time was 5:53 minutes.
Acceptability was high with both patients and clinical staff contributing
positive comments along with suggestions for improvement via email.
Conclusions: This pilot experience suggests that ePRO data can be
efficiently collected among outpatient breast surgery patients with high
acceptability. In the next phase of this project, we will introduce real-time
individual patient reports to the clinical team and evaluate the impact of
this information on clinical care and quality improvement.
Patient and Survivor Care
577s
9041 General Poster Session (Board #38D), Sat, 8:00 AM-12:00 PM
Effect of chemotherapy and psychosocial distress parameters on perceived
cognitive disturbances in Asian breast cancer patients. Presenting Author:
Yin Ting Cheung, National University of Singapore, Singapore
Background: A qualitative study has revealed that Asian breast cancer
patients attributed their post-chemotherapy cognitive disturbances to
psychosocial distress. To validate this claim, we aim to examine perceived
cognitive disturbances, anxiety and quality of life (QoL) in Asian breast
cancer patients and to identify clinical and psychosocial factors associated
with perceived cognitive disturbances. Methods: A prospective, observational
study was held at the largest cancer center in Singapore. Chemotherapy
(CT) and non-chemotherapy (non-CT) receiving breast cancer
patients completed self- reported questionnaires to assess the following
domains: patients’ perceived impact of chemotherapy on cognitive disturbances
(FACT-Cog), health-related QoL (EORTC QLQ-C30) and anxiety
(Beck Anxiety Inventory). Multiple regression was conducted to delineate
factors associated with perceived cognitive impairment. Results: A total of
166 (1:1 CT/non-CT) patients were recruited (age: 54.1�10.2 years;
78.9% Chinese; 53.6% post-menopausal). Most of the CT patients
received anthracycline-based chemotherapy (93.1%) and anti-hormonal
therapy (69.4%). Comparing to non-CT patients, CT patients experienced
more fatigue (QLQ-C30 fatigue scores: 22.2 vs 33.3 points; p�0.005),
more significant anxiety (8.6% vs 21.9%; p�0.002), and more cognitive
disturbances (FACT-Cog scores: 110 vs 124 points; p�0.0001). Regression
model identified chemotherapy, anti-hormonal therapy, emotional
functioning and global health status to be strongly associated with
cognitive disturbances in Asian breast cancer patients. The interacting
effect between anxiety and fatigue, comparing to fatigue alone, was more
associated with cognitive disturbances (��-0.212; p�0.032 vs ��-0.07;
p�0.25, respectively). Conclusions: This is the first study to demonstrate
that Asian breast cancer patients experiencing both fatigue and anxiety are
more predisposed to cognitive disturbances. Post-chemotherapy cognitive
changes are observed in our patients, and our results suggest that
psychosocial factors are impactful to identify cancer patients who are more
susceptible to cognitive disturbances.
9043 General Poster Session (Board #38F), Sat, 8:00 AM-12:00 PM
Patient-reported satisfaction with reconstructed breasts in the long-term
survivorship period: Comparison of autologous and nonautologous breast
reconstruction. Presenting Author: Amie Scott, Memorial Sloan-Kettering
Cancer Center, New York, NY
Background: Breast cancer patients undergoing mastectomy may choose to
have reconstruction performed using either their own tissue or an implant.
As many patients are candidates for both, valid and reliable patientcentered
outcomes data are crucial to shared medical decision-making.
The objective of this study is to determine whether patient-reported
satisfaction with their reconstructed breasts is dependent on type of
reconstructive surgery and length of time from reconstruction. Methods:
Participants were recruited from Memorial Sloan-Kettering Cancer, NY and
the University of British Columbia, Canada. Patients completed the
BREAST-Q, a new patient-reported outcome measure for breast surgery
patients. The dependent variable was the BREAST-Q Satisfaction with
Breast score, a 16-item scale scored from 0-100. Procedure type, time
since surgery, and patient characteristics were independent variables.
Univariate analysis and clinical judgment were used to identify variables
included in the model, and multivariate linear regression models were
constructed to control for confounders. Results: The study sample consisted
of 510 women (response rate 62%). The sample was on average aged 54.3
� 9.3 (range 21-81), surveyed 3.71 years � 1.55 (range 1-9) after
surgery, 66% were reconstructed using an implant. Type of surgery and
laterality were found to be variables that predicted higher patient satisfaction
with their breasts after controlling for radiation therapy, follow-up time,
timing of surgery, age, body mass index, and major complications (surgery
type p�0.001; laterality p�0.001, R-square�0.17). Conclusions: As there
is a growing population of breast cancer survivors, understanding how a
woman’s satisfaction with her reconstructed breasts changes over time is
essential. This study suggests that patient satisfaction with breast reconstruction
depends on the type of reconstruction a woman undergoes. This
patient-centered outcome data can be used to enhance shared medical
decision-making by providing patients with information about realistic
expectations for satisfaction with breasts related to type of surgery chosen.
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