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

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9049 General Poster Session (Board #39D), Sat, 8:00 AM-12:00 PM<br />

Patient-physician communication about code status preferences: A randomized<br />

controlled trial. Presenting Author: Wadih Rhondali, University <strong>of</strong><br />

Texas M. D. Anderson Cancer Center, Houston, TX<br />

Background: Code status discussions are important in cancer care. The best<br />

modality for such discussions has not been established. Our objective was<br />

to determine the impact <strong>of</strong> a physician ending a code status discussion with<br />

a question (autonomy approach) versus a recommendation (beneficence<br />

approach) on patients’ do-not-resuscitate (DNR) preference. Methods:<br />

Patients in a supportive care clinic watched two videos showing a<br />

physician-patient discussion regarding code status. Both videos were<br />

identical except for the ending: one ended with the physician asking for the<br />

patient’s code status preference and the other with the physician recommending<br />

DNR. Patients were randomly assigned to watch the videos in<br />

different sequences. The main outcome was the proportion <strong>of</strong> patients<br />

choosing DNR for the video patient. Results: 78 patients completed the<br />

study. 74% chose DNR after the question video, 73% after the recommendation<br />

video (p�NS). Median physician compassion score was very high<br />

and not different for both videos (p�0.73). 30/30 patients who had chosen<br />

DNR for themselves and 30/48 patients who had not chosen DNR for<br />

themselves chose DNR for the video patient (100% v/s 62%, p�0.001).<br />

Age (OR�1.1/year, p�0.01) and white ethnicity (OR�9.43, p�0.004)<br />

predicted DNR choice for the video patient. Conclusions: Ending DNR<br />

discussions with a question or a recommendation did not impact DNR<br />

choice or perception <strong>of</strong> physician compassion. Therefore, both approaches<br />

are clinically appropriate. All patients who chose DNR for themselves and<br />

most patients who did not choose DNR for themselves chose DNR for the<br />

video patient. Age and race predicted DNR choice.<br />

9051 General Poster Session (Board #39F), Sat, 8:00 AM-12:00 PM<br />

Psychosocial correlates <strong>of</strong> sleep architecture in women with advanced<br />

breast cancer. Presenting Author: Arianna Aldridge Gerry, Stanford University<br />

School <strong>of</strong> Medicine, Stanford, CA<br />

Background: Sleep disturbance is prevalent among metastatic breast<br />

cancer (MBC) patients and few studies have objectively evaluated this<br />

problem using polysomnography (PSG). Disturbed sleep negatively affects<br />

quality <strong>of</strong> life. The current study examines the relationship <strong>of</strong> mood and<br />

family structure with sleep parameters assessed over three nights <strong>of</strong> PSG (2<br />

at-home, 1 in-lab). Methods: MBC patients (n � 103) and healthy controls<br />

(n � 27) were recruited. Patients were 57.8 years (SD � 7.7), non-<br />

Hispanic white (86.3%), and had Karn<strong>of</strong>sky ratings <strong>of</strong> at least 70%.<br />

Multiple regression analyses assessed relationships among depression,<br />

cohabitation, and sleep parameters. Results: Among patients, sleep architecture<br />

was significantly related to depression and marital status/<br />

cohabitation. Women reporting more depressive symptoms had less deep<br />

sleep: lower percentage (B � -.26, p � .01) and fewer minutes <strong>of</strong> REM (B<br />

� -.23, p � .02), lower % (B � -.25, p � .02) and fewer minutes <strong>of</strong> stage 2<br />

sleep (B � -.28, p � .01), and more % stage 1 sleep (B � .28, p � .01).<br />

Marriage/cohabitation was positively related to sleep quality indicators:<br />

less wake time after sleep onset (B � -.20, p � .05), better sleep efficiency<br />

(B � .28, p � .01), more total sleep time (B � .30, p � .01), more minutes<br />

<strong>of</strong> REM (B � .23, p � .02), more stage 2 sleep (B � .27, p � .01), and less<br />

% stage 1 sleep (B � -.27, p � .01). Relative to healthy women, patients<br />

had more sleep stage transitions/hour (B � .21, p � .03), more awakenings<br />

(B � .18, p � .04), and more time awake after sleep onset (B � .21, p �<br />

.02). Slow wave (deep, non-REM) sleep was shorter for patients as<br />

measured by both minutes (B � -.20, p � .04) and % <strong>of</strong> stage 4 sleep (B �<br />

-.23, p � .02). Conclusions: Depressed patients or those living alone have<br />

greater reductions in deep sleep. Relative to healthy women, patients’ sleep<br />

disturbance and quality was worse. These findings demonstrate that the<br />

architecture <strong>of</strong> deep sleep is linked to depression and family structure.<br />

Patient and Survivor Care<br />

579s<br />

9050 General Poster Session (Board #39E), Sat, 8:00 AM-12:00 PM<br />

Smoking habits <strong>of</strong> relatives <strong>of</strong> patients (pts) with cancer. Presenting<br />

Author: Mutlu Hayran, Hacettepe University Institute <strong>of</strong> Oncology, Ankara,<br />

Turkey<br />

Background: We aimed to determine the rate and habitual patterns <strong>of</strong><br />

smoking, intentions <strong>of</strong> cessation, dependence levels and sociodemographic<br />

characteristics <strong>of</strong> relatives <strong>of</strong> cancer patients. Methods: The<br />

smoking habits <strong>of</strong> relatives <strong>of</strong> cancer pts were evaluated with a questionnaire<br />

and Fagerstrom test (FT) <strong>of</strong> nicotine dependence. FT and a questionnaire<br />

form were filled in by the volunteers. The quit rate <strong>of</strong> the relatives <strong>of</strong><br />

the cancer pts was compared with the rates declared in the literature.<br />

Results: A total <strong>of</strong> 560 subjects who have relatives <strong>of</strong> pts with cancer. The<br />

median age <strong>of</strong> those with lower and higher Fagerstrom scores (FS) were 40<br />

years and 42 years, respectively (p�0.001). We found no association<br />

between FS and sociodemographic variables, such as the subject’s medical<br />

status, gender, living in the same house, educational status, family income,<br />

closeness and time spent with the cancer pts. Only 2% <strong>of</strong> the subjects<br />

started smoking after cancer was diagnosed in their relative and almost<br />

20% <strong>of</strong> subjects had quit smoking within the year. Spontaneous quit rates<br />

<strong>of</strong> these subgroup <strong>of</strong> smokers (20%) was significantly higher than reported<br />

self-quit rates (max. ~10%) in the literature (p�0.001). Conclusions: The<br />

FS is known to be helpful in determining who would benefit from a cigarette<br />

smoking cessation program. We also show here that the cancer diagnosis in<br />

a smoker’s family motivates this individual to quit smoking and may create<br />

a time window for any involved health staff to intervene for help. This study<br />

was designed by the Turkish Oncology Group, Epidemiology and Prevention<br />

Subgroup.<br />

Individual characteristics by Fagerstrom score.<br />

Low FS High FS<br />

n % n % p<br />

Sex F 33 27 18 21 0.358<br />

M 89 73 66 79<br />

Education Literate 4 3 4 5 0.183<br />

Primary 45 37 33 39<br />

High 34 28 30 35<br />

University 39 32 18 21<br />

Income �1000 TL 58 49 31 39 0.266<br />

1001-3000 TL 43 36 38 47<br />

�3000 TL 18 15 11 14<br />

Finds smoking bans effective No 44 36 44 48 0.028<br />

Yes 77 64 41 52<br />

Wants pr<strong>of</strong>essional help No 55 46 37 45 0.860<br />

Yes 65 54 46 55<br />

Obeys smoking bans No 10 8 17 20 0.012<br />

Yes 112 92 67 80<br />

Contemplates quitting No 38 31 31 36 0.001<br />

Indecisive 6 5 5 6<br />

Yes 77 64 49 58<br />

9052 General Poster Session (Board #39G), Sat, 8:00 AM-12:00 PM<br />

Mistletoe as complementary treatment in patients with advanced non-small<br />

cell lung cancer treated with carboplatin-based combinations: A randomized<br />

phase II study. Presenting Author: Gil Bar-Sela, Division <strong>of</strong> Oncology,<br />

Rambam Health Care Campus, Haifa, Israel<br />

Background: The mistletoe preparation, iscador, is commonly used in<br />

complementary medicine for improving the quality <strong>of</strong> life (QoL) <strong>of</strong> cancer<br />

patients, but its efficacy needs to be further proved. This randomized phase<br />

II study was aimed at assessing the value <strong>of</strong> iscador as a modifier <strong>of</strong><br />

chemotherapy-induced toxicity in chemotherapy-naïve non-small-cell lung<br />

cancer (NSCLC) patients treated with carboplatin containing regimens.<br />

Methods: Patients with stage IIIA or IIIB/IV NSCLC, ECOG performance<br />

status 0-2, and no history <strong>of</strong> brain metastasis were randomized to receive<br />

either chemotherapy alone (arm-1) or chemotherapy plus iscador Q 10mg<br />

SC injections 3 times weekly until tumor progression (arm-2). Chemotherapy<br />

consisted <strong>of</strong> 21-day cycles <strong>of</strong> IV carboplatin area under curve 5.0,<br />

day 1, combined with IV gemcitabine 1000mg/m2 , days 1, 8, or with IV<br />

pemetrexed 500mg/m2 , day 1. Results: Seventy-two patients were enrolled,<br />

39 to arm-1 and 33 to arm-2. The arms were well balanced except that<br />

more patients with PS-0 were in arm-1 (p�0.041). Most patients (65%)<br />

were in stage IV and 62% had squamous histology. Median overall survival<br />

was 11 months in both arms. Median TTP was 4.8 months (arm-1) and 6<br />

months (arm-2) (p�0.07). Carboplatin dose reductions and delays in<br />

gemcitabine on day 8 were more frequent in arm-1 (44% vs. 13% in arm-2,<br />

p�0.005; 31% vs. 13% in arm-2, p� 0.013). The difference in grade 3-4<br />

hematological toxicity was not significant. More non-hematological toxicity<br />

was observed in arm-1 (41% compared to 16% in arm-2, p�0.043). The<br />

number <strong>of</strong> hospitalizations was higher in arm-1, 54%, compared to 24% in<br />

arm-2 (p�0.016). No significant difference was seen in QoL using the<br />

EORTC QLQ-C30 questionnaire; However, significant improvement in<br />

arm-2 was seen in coughing (p�0.013) and peripheral neuropathy<br />

(p�0.019). Conclusions: Chemotherapy dose reductions, severe nonhematological<br />

side effects, and hospitalizations were less frequent in<br />

patients treated with iscador. Further investigation <strong>of</strong> iscador as a modifier<br />

<strong>of</strong> chemotherapy-related toxicity is warranted.<br />

Visit abstract.asco.org and search by abstract for the full list <strong>of</strong> abstract authors and their disclosure information.

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