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

9130 General Poster Session (Board #49D), Sat, 8:00 AM-12:00 PM
Cognitive symptoms in non-Hodgkin lymphoma survivors: Prevalence and
discussion with doctors. Presenting Author: Neeraj K Arora, National
Cancer Institute, Bethesda, MD
Background: Several studies have documented the negative impact of
chemotherapy on patients’ cognitive functioning. However, this concern
has been understudied among non-Hodgkin Lymphoma (NHL) survivors.
Methods: We analyzed survey data from a population-based study of
survivors diagnosed with aggressive NHL in Los Angeles County 2-5 years
prior to the study; data were collected between 2003-2005. We assessed
prevalence of cognitive symptoms (CS) by a single item screener that asked
if in the past 6 months survivors experienced problems with memory,
attention, or concentration; if yes, we asked if they discussed the problem
with a doctor. Frequency of CS was assessed by a 4 item scale that
measured how often survivors experienced different CS in the past 4 weeks
(none, a little, some, most, all the time). Logistic regression analyses
identified correlates of reporting CS (yes/no) as well as discussion with a
doctor (yes/no). Analyses were based on data from 358 survivors who had
received chemotherapy and saw a doctor for follow-up care in the past year.
Results: 134/358 survivors (37%) reported CS, many reporting difficulty
some, most, or all the time with memory (64%), attention (58%),
concentration (57%), and problem solving (46%). Survivors with higher
education, who were not married/partnered, and who had more comorbidities
were more likely to report CS (p�0.05 for all). Report of CS was not
associated with age, NHL grade, time since completion of chemotherapy,
or having been treated with radiation or bone marrow/stem cell transplant.
Of the 134 survivors who reported CS, only 43% discussed them with a
doctor. Survivors who reported being given information about late effects of
treatment were more likely to discuss CS than those who were not (OR: 3.4,
95% CI 1.4-8.5, p�0.01). Conclusions: One in three NHL survivors
reported CS following chemotherapy; however, a majority did not discuss
these with a doctor. Periodic screening for CS in NHL survivors may be
needed and would provide an opportunity to improve patient-clinician
communication about this issue. Additionally, research that identifies
mechanisms that cause CS in this population is warranted in order to
develop targeted behavioral and medical interventions.
9132 General Poster Session (Board #49F), Sat, 8:00 AM-12:00 PM
Addressing spirituality within the care of patients at the end of life:
Perspectives of advanced cancer patients, oncologists, and oncology
nurses. Presenting Author: Andrea C. Phelps, Dana-Farber Cancer Institute,
Department of Medical Oncology, Boston, MA
Background: Attention to patients’ religious and spiritual needs is included
in national guidelines for quality end-of-life care, but little data exists to
guide spiritual care. Methods: The Religion and Spirituality in Cancer Care
Study is a multi-institution, quantitative-qualitative study of 75 advanced
cancer patients and 339 cancer doctors and nurses. Patients underwent
semi-structured interviews and providers completed a web-based survey
exploring their perspectives on the routine provision of spiritual care by
doctors and nurses. Theme extraction was performed following triangulated
procedures of interdisciplinary analysis. Multivariable ordinal logistic
regression models assessed relationships between participant characteristics
and attitudes toward spiritual care. Results: The majority of patients
(77.9%), physicians (71.6%), and nurses (85.1%) believed that routine
spiritual care would positively impact patients. Only 25% of patients had
previously received spiritual care. Among patients, prior spiritual care
(adjusted odds ratio [AOR], 14.65; 95% CI, 1.51-142.23), increasing
education (AOR, 1.26; 95% CI, 1.06-1.49) and religious coping (AOR,
4.79; 95% CI, 1.40-16.42) were associated with favorable perceptions of
spiritual care. Physicians held more negative perceptions of spiritual care
than patients (p � 0.001) and nurses (p � 0.008). Qualitative analysis
identified benefits of spiritual care, including supporting patients’ emotional
wellbeing and strengthening patient-provider relationships. Objections
to spiritual care frequently related to professional role conflicts.
Participants described ideal spiritual care to be individualized, voluntary,
inclusive of chaplains/clergy, and based upon assessing and supporting
patient spirituality. Conclusions: Most advanced cancer patients, oncologists,
and oncology nurses value spiritual care. Themes described provide
an empiric basis for engaging spiritual issues within clinical care.
Patient and Survivor Care
599s
9131 General Poster Session (Board #49E), Sat, 8:00 AM-12:00 PM
Prevalence of cancer-related fatigue in a population-based sample of
colorectal, breast, and prostate cancer survivors. Presenting Author:
Jennifer M. Jones, University Health Network, Princess Margaret Hospital,
Toronto, ON, Canada
Background: Cancer-related fatigue (CRF) is the most prevalent and
distressing cancer-related symptom and has a greater negative impact on
patients’ daily activities and quality of life than other cancer-related
symptoms, including pain and depression. However, the prevalence and
severity of persistent CRF and related disability in the post-treatment
survivorship period has seldom been examined in populations other than
breast cancer. The primary objective of the study was to describe the
prevalence of significant CRF and associated levels of disability in a mixed
cancer population sample at 3 time points in the post-treatment survivorship
trajectory. Methods: Based on cancer registry data, a self-administered
mail based questionnaire using Dillman’s Tailored Design Method was sent
to 3 cohorts of disease-free cancer survivors (6-18 months; 2-3 years; and
5-6 years post-treatment) previously treated for non-metastatic breast,
prostate or colorectal cancer. Fatigue was measured using the FACT-F and
disability was measured with the WHO-Disability Assessment Schedule.
Clinical information was extracted from chart review. Frequencies of
significant fatigue by disease sites and time points were studied and
compared using chi-square test. Disability between those with and without
CRF was also compared using Cochran-Armitage trend test. Results: 1294
questionnaire packages were completed (63% response rate). The FACT-F
score was 39.1�10.9; 29% (95% CI: [27%, 32%]) of the sample reported
significant fatigue (FACT-F�34) and this was associated with much higher
levels of disability (p�0.0001). Breast (40% [35%, 44%]) and colorectal
(33% [27%, 38%]) survivors had significantly higher rates of fatigue (�34)
compared to the prostate group (17% [14%, 21%]) (p�0.0001). Fatigue
levels remained relatively stable across the 3 time points. Conclusions: CRF
was a significant and debilitating symptom for a substantial minority of the
respondents across all 3 time points. Effective CRF management strategies
are needed and have the potential to significantly reduce morbidity
associated with cancer and its treatments and to improve quality of life for
the growing population of cancer survivors.
9133 General Poster Session (Board #49G), Sat, 8:00 AM-12:00 PM
Palonosetron (PALO) plus 1-day versus 3-day dexamethasone (DEX) with or
without aprepitant against delayed nausea (DN): Pooled analysis for 554
women receiving highly emetogenic chemotherapy (HEC). Presenting
Author: Luigi Celio, Department of Medical Oncology, Fondazione IRCCS
Istituto Nazionale Tumori, Milan, Italy
Background: Nausea is more difficult to control than vomiting, because the
incidence of the symptom continues to rise over the days after chemotherapy.
This post-hoc analysis addressed two questions: 1) Does PALO
plus single-dose DEX result in suboptimal control of DN when compared to
the same regimen with additional DEX doses? 2) Is the combination of
PALO, DEX, and aprepitant a more effective coverage against DN? Methods:
The analysis was based upon outcomes in chemo-naïve women (median age
�52) with solid tumors (89% breast) enrolled in two Phase III and two
Phase II trials of HEC (AC combination or cisplatin). Patients received the
following regimens: 1) PALO 0.25 mg plus DEX 8 mg IV on day 1 of
chemotherapy (1-day regimen, n�243); 2) the same regimen on the day 1
followed by DEX 8 mg orally on days 2 and 3 (3-day regimen, n�207); or
PALO plus DEX plus aprepitant 125 mg on day 1 followed by aprepitant 80
mg on days 2 and 3 (triple regimen, n�104). The pre-specified primary
endpoint was the proportion of patients with no DN (days 2-5 after the first
cycle of chemotherapy). The two primary comparisons were 1-day vs. 3-day
regimen, and triple vs. 3-day regimen, with statistical significance set to
the 0.025 level. Results: The 1-day to 3-day regimen comparison was not
statistically significant (44% vs. 47.8%; risk difference (RD) � -3.8%,
95% CI (-5.4 to 12.9%), P�0.421 (two-sided chi-square test). The triple
to 3-day regimen comparison was also not significant (57.7% vs. 47.8%),
RD��9.9%, 95% CI (-1.9 to 21.3%), P�0.101. More patients receiving
triple regimen experienced no acute-onset nausea compared with those
administered only DEX (97.1% vs. 51.2%, P�0.0001). Conclusions: This
analysis provides evidence that PALO plus 1-day or 3-day DEX yield similar
prevention of DN. The addition of aprepitant does not improve the control of
DN. Complete results utilizing a multivariable model accounting for risk
factors and trial heterogeneity will also be presented.
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