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

9065 General Poster Session (Board #41D), Sat, 8:00 AM-12:00 PM
Clinical needs of patients referred early to supportive and palliative care.
Presenting Author: Jung Hye Kwon, Department of Internal Medicine,
Hallym University Medical Center, Hallym University College of Medicine,
Seoul, South Korea
Background: Palliative care is evolving from delivering care to patients at
the end-of-life to those earlier in the disease trajectory. We evaluated the
differences in clinical characteristics, symptoms burdens, and service
utilization between traditional palliative care patients (late referrals, LR)
and the new patients group who are in earlier in their course of disease
(early referrals, ER). Methods: We reviewed consecutive cancer patients
referred to the Supportive Care Clinic with follow up visit within 30 days
between August 2008 and October 2010. Patients were divided into two
groups: ER (defined as patients with expected survival � 2 years or
receiving treatment for curative intent) and LR (all others). We compared
clinical characteristics, symptoms and service utilization between both
groups using chi-square test and Wilcoxon rank sum test. Results: 58%
(695/1208) patients had a 2nd visit within 30 days. Among them, 100
patients were classified as ER (14.4%) and 100/595 LR were randomly
selected as the comparison group. ER patients were younger (median age
54 years vs 60 years, p�0.009), more likely to have head and neck cancer
(67% vs 6%, p�0.001) and to have a shorter interval between cancer
diagnosis and palliative care consultation (3.8 m vs 16.2 m, �0.001). ER
patients were also more likely to be CAGE positive (15% vs 4%, p�.014),
referred from radiation oncology (49% vs 3%, p�0.001), referred for
treatment related side effects (70% vs 9%, p�0.001), and receiving active
anti-cancer treatment at the time of consultation (74% vs 48%, p�0.0002).
Baseline symptoms (Edmonton Symptom Assessment Scale) were similar
between ER and LR except for insomnia (1.8 vs 2, p�0.004). LR patients
experienced greater improvement in the symptom distress score (-5.5 vs -3,
p�0.007). Overall median number of medical visits was 24 for ER vs 10.5
for LR (p�0.001); however, median visit per month was 4.3 for LR and 2.1
for ER (p�0.001). Conclusions: ER was associated with different patient
characteristics; patients have similar distress but different needs and
outcomes as compared to traditional LR patients.
9067 General Poster Session (Board #41F), Sat, 8:00 AM-12:00 PM
Clostridium difficile-associated diarrhea in cancer patients treated with
fidaxomicin or vancomycin. Presenting Author: Oliver A. Cornely, 1st
Department of Internal Medicine, and Zentrum für Klinische Studien–ZKS
Köln (BMBF 01KN070), University Hospital of Cologne, Koeln, Germany
Background: Oncology patients are at risk for infections, including C
difficile infection (CDI). Fidaxomicin (FDX) is a novel antibiotic highly
specific for C difficile with improved sustained response compared with
vancomycin (VAN). Another important clinical outcome of CDI is time to
resolution of diarrhea (TTROD), corresponding to the duration of passing
unformed bowel movements. Methods: 183 patients with a current diagnosis
of cancer were compared to non-cancer patients from a combined
population of 1105 subjects with CDI in two phase 3 trials comparing 10
days of treatment with FDX (400 mg/day) or VAN (500 mg/day). Number of
unformed bowel movements (UBM) per 24 h was monitored. Response was
considered as �3 UBM/24 h. Time to resolution of diarrhea was defined as
time in hours from the first dose of study drug to the last UBM on the day
preceding two days of �3 UBM/24 h. Kaplan-Meier survival analysis (K-M)
used the log rank test for significance (p�0.05). Results: The response rate
at end of treatment was 79.2% for 183 patients with cancer, compared to
88.6% for 922 patients without cancer (p�0.001). Median TTROD was
longer by 45 h in patients with cancer than those without. In the VAN
treatment group, median TTROD was 65 h longer in patients with cancer vs
those without and significant by K-M. In the FDX group, although median
TTROD was longer by 20 h in patients with cancer vs those without, the
difference was not significant by K-M. For patients with cancer, TTROD was
significantly shorter during treatment with FDX than with VAN. Conclusions:
Patients with cancer responded more slowly to treatment for CDI than did
non-cancer patients; however, resolution of diarrhea was more rapid by 49
h during treatment with FDX than with VAN.
Median TTROD, h (95% CI)
Subgroup
No cancer Cancer K-M log rank p
All patients (N�1105) 55 (53-58) 100 (71-119) �0.001
Treated with FDX (N�539) 54 (48-58) 74 (54-103) 0.145
Treated with VAN (N�566) 58 (54-72) 123 (78-142) �0.001
Fidaxomicin Vancomycin
Patients with cancer (N�183) 74 (54-103) 123 (78-142) 0.045
Patient and Survivor Care
583s
9066 General Poster Session (Board #41E), Sat, 8:00 AM-12:00 PM
Effect of complementary and alternative medicine on the survival and
health-related quality of life among terminally ill cancer patients: A
prospective cohort study. Presenting Author: Young Ho Yun, Seoul National
University College of Medicine, Seoul, South Korea
Background: Few have examined the effect of complementary and alternative
medicine (CAM) use on survival and health-related quality of life
(HRQOL) in cancer patients. Methods: From July 2005 to October 2006, we
conducted a prospective cohort study of 481 terminally ill cancer patients
at 11 university hospitals and the National Cancer Center in Korea. We
assessed how the use of CAM affected HRQOL and survival. Results: In a
follow-up of 481 patients and 163.8 person-years, we identified 466
deceased cases. On multivariate analyses, CAM users did not have better
survival than nonusers (adjusted hazard ratio (aHR), 0.91; 95% confidence
interval (CI), 0.74-1.10). Among biologically based therapies, dietary
supplements (aHR, 0.70; 95% CI, 0.48–1.01) and ginseng (aHR, 0.73;
95% CI, 0.52–1.04) did not show significantly better survival. Among
mind-body interventions, prayer showed significantly worse survival
(aHR,1.56; 95% CI, 1.00–2.43). Clinically, CAM users reported significantly
worse cognitive functioning (-11.6 v -1.3; p � 0.05) and fatigue
(9.9 v -1.0; p � 0.05) than non-users. Compared with non-users in
subgroup analysis, users of alternative medical treatments, prayer, vitamin
supplements, mushrooms, or rice and cereal reported clinically significant
worse changes in some HRQOL subscales. Conclusions: While CAM did not
provide any definite survival benefit, CAM users reported clinically significant
worse HRQOLs.
9068 General Poster Session (Board #41G), Sat, 8:00 AM-12:00 PM
Interdisciplinary palliative care in metastatic non-small-cell lung cancer.
Presenting Author: Marianna Koczywas, City of Hope, Duarte, CA
Background: Palliative cancer care is the integration into cancer care of
therapies that address multiple issues that cause suffering for patients and
their families and impact their life quality. Challenges and barriers
continue to hinder the integration of palliative care into comprehensive,
ambulatory oncology care. This paper aims to describe how symptoms,
distress, and quality of life (QOL) data from the usual care phase of a
NCI-supported Program Project (P01) informed the development of an
interdisciplinary palliative care intervention for patients with metastatic
non-small-cell lung cancer (NSCLC). Methods: Patients receiving usual
care for metastatic NSCLC were recruited into this prospective longitudinal
study. A total of 130 patients with stage IV NSCLC were accrued, and 114
patients had evaluable data. Upon informed consent, patients completed
outcome measures that assessed physical function/cognitive status, social
activities and support, symptom characteristics, psychological distress,
and overall QOL. Patient-reported outcomes were completed at baseline, 6,
12, and 24 weeks post-accrual. Results: Subjects were primarily female
(64%), ranged in age from 40-84 years, and 39% were ethnic minorities.
The majority were former smokers (66%). KPS, IADL, and Cognitive scores
deteriorated significantly over time (p�.001, .009, and .042, respectively).
Patients reported higher severity scores with symptoms such as
dyspnea, fatigue, insomnia, lack of appetite, peripheral neuropathy, pain,
dry skin, nail changes, and problems with sexual interest in all four time
periods. Global Symptom Distress Index and Total Symptom score both
significantly worsened at 24 weeks (p�.003 and .017, respectively).
Physical Well-Being worsened significantly (p�.036), while overall QOL,
spiritual well-being, and psychological distress scores remained statistically
stable over time. Conclusions: Patients with metastatic NSCLC
continue to experience high symptom burden and diminished physical
well-being over time while receiving treatments. An interdisciplinary
palliative care intervention is currently being tested to improve symptom
burden and overall QOL.
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