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

578s Patient and Survivor Care
9044 General Poster Session (Board #38G), Sat, 8:00 AM-12:00 PM
Predictors of resilience in women treated for breast cancer: A prospective
study. Presenting Author: Barbara Kaye Bennett, University of New South
Wales, Sydney, Australia
Background: Because a cancer diagnosis may be regarded as a potentially
traumatic event with untoward consequences, much research has focussed
on negative aspects of cancer diagnosis and treatment, emphasising
psychological outcomes. A recent paradigm shift recognises that such a
psycho-pathological approach discounts the human capacity for resilience
�the ability to maintain relatively stable functioning following an aversive
life event� (Bonanno GA Curr Direct in Psychol Science 2005 14(3) 135).
Predictors of resilience in women who recovered uneventfully from surgical
and adjuvant treatment for early stage breast cancer were investigated in a
prospective study. Methods: Validated self-report measures of mood,
somatic symptoms, temperament, illness attitudes, and social support
were completed post-surgery. Clinical, tumor and treatment details were
recorded. At end treatment and subsequently at 1, 3, 6, 9 and 12 months,
self-report measures of mood and somatic symptoms were completed.
Resilience was defined as: no evidence of protracted psychological or
somatic distress in the 12 months following treatment completion. Identified
resilient and non-resilient groups were compared and predictors sought
by logistic regression. Results: Of 218 women evaluated, 106 (49%) were
classified as �resilient.� They either reported no clinically significant
psychological or other distress post-surgery (34%) and 12months following
adjuvant treatment or recovered promptly (15%) and remained well. There
were no significant differences in age (52 years); marital status; tumor size;
treatment; treatment toxicity (nadir hemoglobin and neutrophil count) or
mortality at 5 years post treatment (8 confirmed deaths in each group).
Logistic regression identified low neuroticism (temperament or personality
trait) as the most significant predictor of resilience. Conclusions: These
findings suggest that without any intervention almost half the women
treated for breast cancer adapt well to diagnosis and treatment. These
outcomes warrant further research, to provide further insight into how
individuals cope with major illness and to facilitate development of
programs to aid those in whom outcomes are protracted.
9046 General Poster Session (Board #39A), Sat, 8:00 AM-12:00 PM
Patient-related factors influencing time between first signs of breast cancer
(BC) and appointment for medical visit (AMV): An international survey.
Presenting Author: Jacek Jassem, Klinika Onkologii i Radioterapii Gdanski
Uniwersytet Medyczny, Gdansk, Poland
Background: Reducing diagnostic delays may improve treatment outcomes
in BC. We investigated in various countries patient-related factors influencing
time to seeking medical advice for signs of BC. Methods: A total of
4,816 female BC patients from 10 countries were surveyed using a uniform
questionnaire translated into local languages. Time between first patientdetected
signs of BC and AMV was measured using categorized time scales.
Out of 14 original items on a multiple scale measuring BC-related attitudes
and behaviors, 5 factors were extracted and used for further analysis:
distrust in medical system and success of therapy, disregard of signs, fear
of BC, practicing regular breast self-examination and support from friends
and family. Results: In the subset of 2,870 patients with self-detected BC
who provided complete answers to relevant variables, the mean time to
AMV varied in particular countries from 3.4 to 6.2 weeks (grand mean of
4.7 weeks), with 39% of cases with a delay of �4 weeks. Overall, patient
attributes that significantly influenced time to AMV were: distrust (p�1E-
36), disregard (p�1.26E-30), fear (p�2.65E-16), self-examination
(p�1.31E-21), place of living (p�3.5E-3) and education (p�2.73E-3).
Multilevel analysis indicated that significant differences among particular
countries were only due to slopes of distrust and disregard included in
general regression model. The model enhanced with the two abovementioned
random effects provided significant improvement in predicting time
to AMV. Re-estimation of the model based solely on data from individual
countries produced 10 significant equations with varied coefficients for
distrust and disregard (see table). Conclusions: Patient-related factors
contribute considerably to delay in the diagnosis of BC. Differences
between particular countries call for country-specific approaches.
Country Distrust Country Disregard
Romania 2.3 Turkey 1.5
Serbia 1.7 Serbia 1.5
Slovakia 1.5 Latvia 1.4
Hungary 1.4 Slovakia 1.1
Latvia 1.2 Poland 1.0
Poland 1.1 Russian Fed. 1.0
Russian Fed. 0.9 Bulgaria 1.0
Lithuania 0.9 Lithuania 0.6
Bulgaria 0.7 Hungary 0.4
Turkey 0.03 Romania -0.9
9045 General Poster Session (Board #38H), Sat, 8:00 AM-12:00 PM
Predictors of satisfaction with decision in patients with advanced cancer.
Presenting Author: Felicitas Hitz, Department of Medical Oncology, Kantonsspital
St.Gallen, St. Gallen, Switzerland
Background: Treatment decisions in palliative cancer care depend on
various patient-, treatment, and disease-related factors. This study investigated
patients’ satisfaction with decision and decision-making preferences
in a Swiss oncology network and evaluated factors that predict satisfaction
with decision (SWD). Methods: Patients receiving a new line of palliative
cancer treatment completed a multi-dimensional questionnaire 4-6 weeks
after treatment decision. Patient-reports comprised socio-demographic
information, satisfaction with decision (primary endpoint), subjective
treatment goal, preferences for decision-making, health, locus of control,
and several quality of life (QoL) domains. Information on diagnosis, line of
therapy, metastases, prognosis, performance status and duration of consultation
were provided by the attending physician. Predictors of SWD (range:
0�worst; 30�best) were evaluated by uni- and multivariate (primary
analysis, 80% power, 5% significance level) regression models. We
consider �24 points as high SWD. Results: 445 out of 480 patients treated
in 8 hospitals and 2 private practices completed all questions regarding the
primary endpoint. 44% of patients preferred shared-, 42% physiciancentered
decision making. Median duration of consultation was 30 minutes
(range 10-200 minutes). Overall, 326 (73%) patients reported high SWD.
In univariate analyses various factors (e.g. global and physical QoL,
performance status, treatment goal, locus of control, prognosis and
duration of consultation) were significant predictors of SWD. The only
significant predictor in the multivariate analysis was duration of consultation,
which was positively associated with SWD (p�0.01). Conclusions:
SWD is generally high in patients with advanced cancer treated in an
oncology network in Switzerland. Our results indicate that duration of
consultation is a very important factor among many others in predicting
SWD. In busy clinical practice, taking your time with patients may be a
simple measure to enhance patients’ SWD.
9047 General Poster Session (Board #39B), Sat, 8:00 AM-12:00 PM
Validity and reliability of the patient-reported outcomes version of the
common terminology criteria for adverse events (PRO-CTCAE). Presenting
Author: Amylou C. Dueck, Mayo Clinic, Scottsdale, AZ
Background: Symptomatic adverse events (AE) in cancer trials are reported
by clinicians using the National Cancer Institute’s (NCI) Common Terminology
Criteria for Adverse Events (CTCAE). To integrate the patient perspective
into AE reporting, NCI contracted (HHSN261201000043C) to create
a patient-reported outcomes companion tool (PRO-CTCAE). We report the
validity and reliability of PRO-CTCAE’s 124 items reflecting 78 symptomatic
AEs. Methods: English-speaking subjects (n�869; 44% male; median
[mdn] age 59; 32% racial/ethnic minority; 34% high school or less; 17%
ECOG Performance Status [PS] 2-4) receiving treatment for a range of
cancers at 4 NCI-designated cancer centers and 5 sites in NCI’s Community
Cancer Centers Program completed a web-based survey in clinic
including PRO-CTCAE and EORTC QLQ-C30. Pearson correlations were
computed between PRO-CTCAE items and QLQ-C30 scales. Differences in
PRO-CTCAE item scores between clinician-reported ECOG PS (0-1 vs 2-4)
groups were computed. Test-retest reliability of 48 prespecified items was
evaluated in a subset (n�79). Results: Correlations in the expected
direction were observed for 116/124 PRO-CTCAE items with the QLQ-C30
global health scale (mdn r�-.21; range .08 to -.57). Stronger correlations
were seen for PRO-CTCAE items with conceptually related QLQ-C30
domains: fatigue with physical, role and social functioning (-.54 to -.66);
anxiety and depression with emotional functioning (-.54 to -.70); and
concentration and memory problems with cognitive functioning (-.62 to
-.72) [all p �0.001]. Fatigue, nausea, vomiting, pain, dyspnea, insomnia,
appetite loss, constipation and diarrhea items strongly correlated with
corresponding QLQ-C30 symptom scales (.69 to .79, all p �0.001).
Scores for 98/124 PRO-CTCAE items were higher in the ECOG PS 2-4 vs
0-1 group (mdn effect size .3). Test-retest reliability was observed across
all tested items (mdn intraclass correlation coeff .77; range .53 to .96).
Conclusions: Results demonstrate favorable validity and reliability of
PRO-CTCAE in a large, heterogeneous sample of patients undergoing
cancer treatment. Further testing in multicenter treatment trials is underway.
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