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

9098 General Poster Session (Board #45D), Sat, 8:00 AM-12:00 PM
Medical oncologist’s commitment in the end of life (EoL) care of cancer
patients: The caregiver’s perspective. Presenting Author: Romeo Bascioni,
Ospedale Murri, Fermo, Italy
Background: Optimizing the impact of EoL care on cancer patients (pts) and
their caregivers should be a primary goal of an oncology unit. In this study
we evaluated satisfaction of family caregivers when the medical oncology
team assisted pts until death. Methods: Two oncology units were reorganized
to ensure continuity of care; oncologists trained in palliative care
medicine assisted pts until EoL. The model assumes that the medical
oncologist (MO) is the physician in charge throughout the entire disease
trajectory. Relatives of pts assisted at home or at an inpatient hospice
underwent a semistructured phone interview conducted by a psychologist
or a social worker � 1 month after pts’ death. Satisfaction was evaluated for
symptoms control, communication, psychological support, overall quality
of care and continuity of therapeutic relationship with the MO. A final
open-ended question was included for any additional comment. Satisfaction
was measured using a five-point Likert scale ranging from very
dissatisfied to very satisfied and converted to a 0-to-100 scale. Results:
Relatives of 65 pts were contacted, 55 accepted the interview (27 spouses,
22 sons, 5 in-laws, 1 parent); 50/55 were the leader caregiver. Patients
were followed at home (41) or at an inpatient hospice (14), for 1-24 wks.
Satisfaction mean scores were: symptoms control 76/100, communication
85, psychological support 82 and overall quality of care 87; a specific
question on the relevance of the MO in EoL care produced a score of 87,
with no negative or neutral responses recorded for this item. Of note, a
common perception among caregivers was the appreciation of the MO’s
commitment during EoL in addition to the technical quality of the
intervention. The overall satisfaction score was higher than in our previous
study in which a continuity of care model was not formally adopted, with a
score improvement from 55 to 87/100. Conclusions: A care pathway where
the MO is involved in EoL management of cancer pts improved satisfaction
of caregivers.When a longstanding and trusting relationship has been
established, the pts-MO connection should not be lost to prevent feelings of
abandonment.
9100 General Poster Session (Board #45F), Sat, 8:00 AM-12:00 PM
Sexual functioning in young women with breast cancer. Presenting Author:
Shoshana Rosenberg, Harvard School of Public Health, Boston, MA
Background: Sexual dysfunction is a known complication of adjuvant
therapy for breast cancer and an important determinant of quality of life.
Little is known about the frequency and magnitude of this problem among
very young women with breast cancer during the year following diagnosis.
Methods: 298 sexually-active women enrolled in an ongoing multi-center
cohort study with Stage 0-III breast cancer at or before age 40 were
included in this analysis. Treatment data was self-reported on a survey
mailed to participants at enrollment. Sexual functioning was assessed
using the sexual interest and dysfunction subscales from the Cancer
Rehabilitation Evaluation System (CARES). Scores range from 0-4, with
higher scores indicative of poorer function. The survey included a measure
of anxiety and depression (Hospital Anxiety and Depression Scale), of body
image (CARES) and of physical and menopausal symptoms (Breast Cancer
Prevention Trial Symptom Checklist). Mean differences in CARES scores
between treatment groups (chemotherapy vs. none; hormone therapy vs.
none; lumpectomy vs. mastectomy vs. mastectomy � reconstruction vs. no
surgery; radiation vs. none) were compared using T-tests and ANOVA.
Multiple regression models were fit to assess symptoms thought to be
mediators of the treatment-sexual functioning association. Results: Mean
age at diagnosis was 36 (range: 22-40) years and mean time from diagnosis
to survey completion was 5 months (range: 1-16). Mean CARES sexual
interest and dysfunction scores were higher in women who received
chemotherapy compared to those who did not (p�0.0001). In the
multivariate analysis, chemotherapy was no longer associated with decreased
sexual interest or function. Anxiety, depression, musculoskeletal
pain, and poorer body image were predictive of both decreased sexual
interest and function. Vaginal pain symptoms were associated with greater
dysfunction, while unhappiness with appearance was associated with
decreased interest. Conclusions: Young women who receive chemotherapy
are at risk for problems related to sexual functioning early in the survivorship
period. This effect appears to be mediated through several physiologic
and psychologic mechanisms, underscoring the need for interventions that
target both.
Patient and Survivor Care
591s
9099 General Poster Session (Board #45E), Sat, 8:00 AM-12:00 PM
Defining mild, moderate, and severe fatigue in cancer patients and
survivors: E2Z02, a trial of the Eastern Cooperative Oncology Group.
Presenting Author: Xin Shelley Wang, University of Texas M. D. Anderson
Cancer Center, Houston, TX
Background: Although mild, moderate and severe categories have been
used in clinical guidelines for fatigue management in cancer patients, the
optimal cutpoints on a 0-10 scale for delineating these categories have not
been replicated. Methods: A multicenter ECOG study (E2Z02) enrolled
breast, lung, prostate, or colorectal cancer patients with any treatment
status. Fatigue and symptom interference were measured on the 0-10
numerical rating scale of the M. D. Anderson Symptom Inventory (MDASI).
The optimal boundaries for categorizing fatigue severity were determined
by the largest F ratios from MANOVA (Serlin’s criteria, 1995). Logistic
regression with robust standard errors was used to identify risk factors for
moderate/severe fatigue for cancer survivors (defined as patients with no
evidence of disease and receiving no cancer treatment). Results: The
optimal cutpoints that identified 3 distinct levels of fatigue severity for the
2341 patients were: ratings of 1-3 as mild, 4-6 as moderate, and 7-10 as
severe. Known-group validity for these cutpoints was established by
significant differences of fatigue severity by ECOG performance status and
patient-reported quality of life (all P�0.001). Using these cutpoints, 45%
(983/2177) of patients undergoing active therapy had moderate/severe
fatigue, with significant more mild fatigue in breast and colorectal cancer
patients, while more severe fatigue in lung cancer patients (p�.001).
Among cancer survivors, 29% (150/515) had moderate/severe fatigue
(breast 31%, colorectal 27%, prostate 22%, lung 33%). Younger age
(OR�0.97, 95% CI�0.95-0.99) and poor performance status (OR�4.21,
95% CI�2.36-7.51) were associated with more moderate/severe fatigue in
cancer survivors. Survivor time was also associated with moderate/severe
fatigue in breast and colorectal cancer survivors (��5yrs vs. �5yrs:
OR�0.23, P�0.01 for breast, OR�9.3, P�0.03 for colorectal).
Conclusions: This multicenter study confirmed the standard cutpoints for
fatigue severity used in NCCN fatigue management guidelines. It also
provides a profile of moderate to severe fatigue prevalence for actively
treated cancer patients and for cancer survivors.
9101 General Poster Session (Board #45G), Sat, 8:00 AM-12:00 PM
Early outpatient palliative care in patients with metastatic NSCLC: A
qualitative study. Presenting Author: Jaclyn Yoong, Massachusetts General
Hospital Cancer Center, Boston, MA
Background: Early outpatient palliative care (PC) is an emerging practice
and its key components have not been defined. We conducted a qualitative
analysis of data from a randomized controlled trial which demonstrated
improved quality of life, mood and survival in outpatients who received
early PC integrated with standard oncologic care versus standard oncologic
care alone. Our objectives were to 1) identify the content and key
components of early PC clinic visits, 2) explore timing of key components,
and 3) compare the content of PC and oncology visit notes at the critical
time points of clinical deterioration and radiographic disease progression.
Methods: We chose a random selection of 20 patients with newly diagnosed
metastatic NSCLC who received early PC who survived within 4 time
frames: less than 3 months (n�5), 3 to 6 months (n�5), 6 to 12 months
(n�5) and 12 to 24 months (n�5). We performed content analysis on PC
and oncology electronic health record notes of these patients using NVivo 9
software. Results: Addressing symptoms and coping ability were the most
prevalent components of the PC clinic visits. The content of initial visits
focused on building relationships and rapport with patients and their
families and illness understanding. Discussions about prognostic awareness
occurred during earlier visits while goals of care and hospice
discussions occurred in later visits. The frequency of addressing these
components was similar regardless of patients’ length of life. Comparing PC
and oncology visits around critical time points, both included discussions
about current illness status and goals of care; however PC visits emphasized
symptoms, coping, and implications of anti-cancer treatments, while
oncology visits focused on medical discussions about treatment plans.
Conclusions: Early PC clinic visits emphasize managing symptoms, strengthening
coping, and cultivating illness understanding and prognostic awareness
in a structured, responsive and time-sensitive model. Around critical
clinical time points PC and oncology visits have distinct features that
suggest a key role for PC involvement while enabling oncologists to focus on
anti-cancer management.
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