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

9049 General Poster Session (Board #39D), Sat, 8:00 AM-12:00 PM
Patient-physician communication about code status preferences: A randomized
controlled trial. Presenting Author: Wadih Rhondali, University of
Texas M. D. Anderson Cancer Center, Houston, TX
Background: Code status discussions are important in cancer care. The best
modality for such discussions has not been established. Our objective was
to determine the impact of a physician ending a code status discussion with
a question (autonomy approach) versus a recommendation (beneficence
approach) on patients’ do-not-resuscitate (DNR) preference. Methods:
Patients in a supportive care clinic watched two videos showing a
physician-patient discussion regarding code status. Both videos were
identical except for the ending: one ended with the physician asking for the
patient’s code status preference and the other with the physician recommending
DNR. Patients were randomly assigned to watch the videos in
different sequences. The main outcome was the proportion of patients
choosing DNR for the video patient. Results: 78 patients completed the
study. 74% chose DNR after the question video, 73% after the recommendation
video (p�NS). Median physician compassion score was very high
and not different for both videos (p�0.73). 30/30 patients who had chosen
DNR for themselves and 30/48 patients who had not chosen DNR for
themselves chose DNR for the video patient (100% v/s 62%, p�0.001).
Age (OR�1.1/year, p�0.01) and white ethnicity (OR�9.43, p�0.004)
predicted DNR choice for the video patient. Conclusions: Ending DNR
discussions with a question or a recommendation did not impact DNR
choice or perception of physician compassion. Therefore, both approaches
are clinically appropriate. All patients who chose DNR for themselves and
most patients who did not choose DNR for themselves chose DNR for the
video patient. Age and race predicted DNR choice.
9051 General Poster Session (Board #39F), Sat, 8:00 AM-12:00 PM
Psychosocial correlates of sleep architecture in women with advanced
breast cancer. Presenting Author: Arianna Aldridge Gerry, Stanford University
School of Medicine, Stanford, CA
Background: Sleep disturbance is prevalent among metastatic breast
cancer (MBC) patients and few studies have objectively evaluated this
problem using polysomnography (PSG). Disturbed sleep negatively affects
quality of life. The current study examines the relationship of mood and
family structure with sleep parameters assessed over three nights of PSG (2
at-home, 1 in-lab). Methods: MBC patients (n � 103) and healthy controls
(n � 27) were recruited. Patients were 57.8 years (SD � 7.7), non-
Hispanic white (86.3%), and had Karnofsky ratings of at least 70%.
Multiple regression analyses assessed relationships among depression,
cohabitation, and sleep parameters. Results: Among patients, sleep architecture
was significantly related to depression and marital status/
cohabitation. Women reporting more depressive symptoms had less deep
sleep: lower percentage (B � -.26, p � .01) and fewer minutes of REM (B
� -.23, p � .02), lower % (B � -.25, p � .02) and fewer minutes of stage 2
sleep (B � -.28, p � .01), and more % stage 1 sleep (B � .28, p � .01).
Marriage/cohabitation was positively related to sleep quality indicators:
less wake time after sleep onset (B � -.20, p � .05), better sleep efficiency
(B � .28, p � .01), more total sleep time (B � .30, p � .01), more minutes
of REM (B � .23, p � .02), more stage 2 sleep (B � .27, p � .01), and less
% stage 1 sleep (B � -.27, p � .01). Relative to healthy women, patients
had more sleep stage transitions/hour (B � .21, p � .03), more awakenings
(B � .18, p � .04), and more time awake after sleep onset (B � .21, p �
.02). Slow wave (deep, non-REM) sleep was shorter for patients as
measured by both minutes (B � -.20, p � .04) and % of stage 4 sleep (B �
-.23, p � .02). Conclusions: Depressed patients or those living alone have
greater reductions in deep sleep. Relative to healthy women, patients’ sleep
disturbance and quality was worse. These findings demonstrate that the
architecture of deep sleep is linked to depression and family structure.
Patient and Survivor Care
579s
9050 General Poster Session (Board #39E), Sat, 8:00 AM-12:00 PM
Smoking habits of relatives of patients (pts) with cancer. Presenting
Author: Mutlu Hayran, Hacettepe University Institute of Oncology, Ankara,
Turkey
Background: We aimed to determine the rate and habitual patterns of
smoking, intentions of cessation, dependence levels and sociodemographic
characteristics of relatives of cancer patients. Methods: The
smoking habits of relatives of cancer pts were evaluated with a questionnaire
and Fagerstrom test (FT) of nicotine dependence. FT and a questionnaire
form were filled in by the volunteers. The quit rate of the relatives of
the cancer pts was compared with the rates declared in the literature.
Results: A total of 560 subjects who have relatives of pts with cancer. The
median age of those with lower and higher Fagerstrom scores (FS) were 40
years and 42 years, respectively (p�0.001). We found no association
between FS and sociodemographic variables, such as the subject’s medical
status, gender, living in the same house, educational status, family income,
closeness and time spent with the cancer pts. Only 2% of the subjects
started smoking after cancer was diagnosed in their relative and almost
20% of subjects had quit smoking within the year. Spontaneous quit rates
of these subgroup of smokers (20%) was significantly higher than reported
self-quit rates (max. ~10%) in the literature (p�0.001). Conclusions: The
FS is known to be helpful in determining who would benefit from a cigarette
smoking cessation program. We also show here that the cancer diagnosis in
a smoker’s family motivates this individual to quit smoking and may create
a time window for any involved health staff to intervene for help. This study
was designed by the Turkish Oncology Group, Epidemiology and Prevention
Subgroup.
Individual characteristics by Fagerstrom score.
Low FS High FS
n % n % p
Sex F 33 27 18 21 0.358
M 89 73 66 79
Education Literate 4 3 4 5 0.183
Primary 45 37 33 39
High 34 28 30 35
University 39 32 18 21
Income �1000 TL 58 49 31 39 0.266
1001-3000 TL 43 36 38 47
�3000 TL 18 15 11 14
Finds smoking bans effective No 44 36 44 48 0.028
Yes 77 64 41 52
Wants professional help No 55 46 37 45 0.860
Yes 65 54 46 55
Obeys smoking bans No 10 8 17 20 0.012
Yes 112 92 67 80
Contemplates quitting No 38 31 31 36 0.001
Indecisive 6 5 5 6
Yes 77 64 49 58
9052 General Poster Session (Board #39G), Sat, 8:00 AM-12:00 PM
Mistletoe as complementary treatment in patients with advanced non-small
cell lung cancer treated with carboplatin-based combinations: A randomized
phase II study. Presenting Author: Gil Bar-Sela, Division of Oncology,
Rambam Health Care Campus, Haifa, Israel
Background: The mistletoe preparation, iscador, is commonly used in
complementary medicine for improving the quality of life (QoL) of cancer
patients, but its efficacy needs to be further proved. This randomized phase
II study was aimed at assessing the value of iscador as a modifier of
chemotherapy-induced toxicity in chemotherapy-naïve non-small-cell lung
cancer (NSCLC) patients treated with carboplatin containing regimens.
Methods: Patients with stage IIIA or IIIB/IV NSCLC, ECOG performance
status 0-2, and no history of brain metastasis were randomized to receive
either chemotherapy alone (arm-1) or chemotherapy plus iscador Q 10mg
SC injections 3 times weekly until tumor progression (arm-2). Chemotherapy
consisted of 21-day cycles of IV carboplatin area under curve 5.0,
day 1, combined with IV gemcitabine 1000mg/m2 , days 1, 8, or with IV
pemetrexed 500mg/m2 , day 1. Results: Seventy-two patients were enrolled,
39 to arm-1 and 33 to arm-2. The arms were well balanced except that
more patients with PS-0 were in arm-1 (p�0.041). Most patients (65%)
were in stage IV and 62% had squamous histology. Median overall survival
was 11 months in both arms. Median TTP was 4.8 months (arm-1) and 6
months (arm-2) (p�0.07). Carboplatin dose reductions and delays in
gemcitabine on day 8 were more frequent in arm-1 (44% vs. 13% in arm-2,
p�0.005; 31% vs. 13% in arm-2, p� 0.013). The difference in grade 3-4
hematological toxicity was not significant. More non-hematological toxicity
was observed in arm-1 (41% compared to 16% in arm-2, p�0.043). The
number of hospitalizations was higher in arm-1, 54%, compared to 24% in
arm-2 (p�0.016). No significant difference was seen in QoL using the
EORTC QLQ-C30 questionnaire; However, significant improvement in
arm-2 was seen in coughing (p�0.013) and peripheral neuropathy
(p�0.019). Conclusions: Chemotherapy dose reductions, severe nonhematological
side effects, and hospitalizations were less frequent in
patients treated with iscador. Further investigation of iscador as a modifier
of chemotherapy-related toxicity is warranted.
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