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

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600s Patient and Survivor Care<br />

9134 General Poster Session (Board #49H), Sat, 8:00 AM-12:00 PM<br />

Longitudinal study <strong>of</strong> hope, meaning/peace (M/P), and quality <strong>of</strong> life (QOL)<br />

in patients (pts) with ovarian cancer (OC). Presenting Author: Lois M.<br />

Ramondetta, University <strong>of</strong> Texas M. D. Anderson Cancer Center, Houston,<br />

TX<br />

Background: M/P may be the most valued end point <strong>of</strong> life. How hope, faith,<br />

physical and psychological factors impact M/P is unknown. We evaluated<br />

factors affecting M/P in pts with OC. Methods: OC pts at a cancer center<br />

(CC), academic hospital (AH) and county hospital (CH for primarily<br />

uninsured) participated. Surveys completed at initiation <strong>of</strong> chemotherapy<br />

(CTX); completion <strong>of</strong> CTX; and 1 yr later. Surveys included FACT-O, -SP,<br />

Herth Hope Index, Hospital Anxiety and Depression Scale (HADS), ESAS,<br />

and Locus <strong>of</strong> Control (LOC). Results: N�115. Median age�55 yrs, married<br />

64%, Christian 96%. CH had more AA/Hispanics pts (p�.001) and<br />

unmarried pts (p�.001). QOL and symptoms improved for all sites over<br />

time (p �.03); CH pts had the worst scores (p� �.001). CC pts expressed<br />

more hope, less anxiety and depression (A/D) compared to CH and AC pts<br />

for all time points (p�.03). CH pts had higher and increasing A/D over time<br />

while CC pts had the least (p�.02). LOC scores differed by site (p�.01).<br />

CH pts held strongest belief that life was controlled by chance and<br />

“others”; CC pts had the least. There was no association between site/time<br />

for belief <strong>of</strong> internal control over one’s life. CH pts consistently had the<br />

lowest M/P scores (p�004). Adjusting for site, disease status and time,<br />

higher M/P associated with higher hope, better QOL, symptoms and faith<br />

(p� �.0001). Lower M/P associated with increased A/D (p�.003) and<br />

symptoms (p�.0001). Poorer M/P over time correlated with belief that life<br />

was controlled by chance (p�.01) and �powerful others�(p�.02). Level <strong>of</strong><br />

M/P did not correlate with belief <strong>of</strong> internal control over one’s life.<br />

Conclusions: M/P did not change over time. CC pts had highest M/P. Higher<br />

M/P associated with higher hope and faith, better QOL, less symptoms and<br />

A/D. Lower M/P associated with sense that life is controlled by chance and<br />

powerful others. Data show medically underserved pts have poorer QOL,<br />

more symptoms and A/D and may believe the future is determined by<br />

luck/chance and by “others”. Triaging for spiritual crisis may be important<br />

in these pts. Interventions to decrease A/D and symptoms may improve pts’<br />

sense <strong>of</strong> M/P over the cancer journey.<br />

9136 General Poster Session (Board #50B), Sat, 8:00 AM-12:00 PM<br />

Associations between receipt <strong>of</strong> a treatment summary, emotional concerns,<br />

and patterns <strong>of</strong> care among post-treatment cancer survivors. Presenting<br />

Author: Ruth Rechis, LIVESTRONG, Austin, TX<br />

Background: Treatment summaries (TS), a critical component <strong>of</strong> survivorship<br />

care plans, were identified as a tool to improve long-term outcomes for<br />

the 12 million cancer survivors alive in the US. Methods: In 2010, the<br />

Lance Armstrong Foundation fielded the LIVESTRONG Survey for People<br />

Affected by Cancer. Respondents were recruited through several channels<br />

including partnerships with national organizations such as ASCO. Over a 9<br />

month period, more than people completed the survey, including 3,682<br />

post-treatment cancer survivors (PTCS). The survey addressed posttreatment<br />

concerns including receipt <strong>of</strong> TS. Full survey results were<br />

presented at the 2011 ASCO Conference. Results: Receipt <strong>of</strong> TS data was<br />

available for 3042 PTCS: average age (50); female (65%); average time<br />

since diagnosis (6 years); received a TS (34%). PTCS who received TS<br />

reported that they were: Closer to time since diagnosis or since treatment<br />

ended (p�0.01); more likely to have received chemotherapy (p�0.01);<br />

more <strong>of</strong>ten receiving the majority <strong>of</strong> their health care from a medical<br />

oncologist (p�0.05); experiencing significantly fewer (p�0.05) posttreatment<br />

emotional concerns (including emotional distress; fears <strong>of</strong><br />

recurrence; concerns about family risk; and appearance concerns) and<br />

were more likely to have received care; significantly less likely to say that<br />

they had “learned to live with” their concerns (p�0.05) – the most<br />

common reason among participants for not receiving care. Finally, receipt<br />

<strong>of</strong> a TS was related to higher information efficacy (p�0.01; which appeared<br />

to mediate the relationship between receipt <strong>of</strong> a TS and fewer emotional<br />

concerns). PTCS who received a TS more <strong>of</strong>ten reported that their needs<br />

were met including information received about possible late-effects; care<br />

they got during treatment; and care they received after treatment.<br />

Conclusions: These results support the provision <strong>of</strong> TS to PTCS. Receipt <strong>of</strong><br />

TS was associated with a variety <strong>of</strong> positive outcomes; however, only about<br />

one-third <strong>of</strong> PTCS received one. Future studies focused on patient<br />

perspectives on care planning tools, such as treatment summaries and care<br />

plans, can help to improve optimal survivorship care delivery.<br />

9135 General Poster Session (Board #50A), Sat, 8:00 AM-12:00 PM<br />

Prospective cohort study <strong>of</strong> chemotherapy-associated toxicity and supportive<br />

care in oncology practice. Presenting Author: Eva Culakova, Duke<br />

University, Durham, NC<br />

Background: Neutropenic complications remain important dose-limiting<br />

toxicities <strong>of</strong> cancer chemotherapy associated with considerable morbidity,<br />

mortality and cost. The risk <strong>of</strong> the initial neutropenic event is greatest in the<br />

first cycle when most patients are receiving full dose chemotherapy.<br />

Methods: A prospective cohort study <strong>of</strong> adult patients with solid tumors or<br />

lymphoma receiving a new chemotherapy regimen was conducted at 115<br />

U.S. practice sites between 2002 and 2006. Chemotherapy-associated<br />

toxicities were captured in up to 4 cycles including severe neutropenia<br />

(SN), febrile neutropenia (FN), and infection. Documented interventions<br />

included colony-stimulating factor (CSF) and antibiotics use and reductions<br />

in chemotherapy relative dose intensity (RDI). Results: Results are<br />

available on 3,638 patients starting chemotherapy <strong>of</strong> which 3,301, 2,937,<br />

and 2,199 went on to cycles 2, 3, and 4, respectively. The majority <strong>of</strong><br />

neutropenic and infection events occurred in cycle 1. A significant inverse<br />

relationship was observed between subsequent reductions in neutropenic<br />

and infectious events and efforts to reduce these complications (Table).<br />

Most patients with stage 4 solid tumors underwent reductions in chemotherapy<br />

RDI. Patients with lymphoma and stage 1-3 solid tumors were less<br />

likely to undergo dose reductions with half or more receiving prophylactic<br />

CSFs during treatment. Approximately 15% <strong>of</strong> patients also received<br />

prophylactic antibiotics. Conclusions: While the risk <strong>of</strong> neutropenic complications<br />

remains greatest during the initial cycle <strong>of</strong> chemotherapy, clinician<br />

efforts to reduce the risk <strong>of</strong> these events vary with cancer type and stage.<br />

Reduced dose intensity is evident in two-thirds <strong>of</strong> patients with advanced<br />

solid tumors whereas the CSFs are employed in half to two-thirds <strong>of</strong><br />

patients with early stage solid tumors or lymphoma.<br />

Percent <strong>of</strong> patients (%)<br />

Cycle-specific events Cumulative events<br />

Solid tumor Solid tumor<br />

Measure<br />

1 2 3 4 Lymphoma stage 1-3 stage 4<br />

FN 6.4 3.8 2.9 0.8 13.7 11.9 7.8<br />

SN or FN 20.0 14.4 13.5 14.3 37.3 33.4 20.6<br />

Infection 12.6 9.4 8.6 1.7 27.5 23.6 21.1<br />

Proph CSF 21.2 38.9 47.9 53.7 63.5 49.5 35.2<br />

Proph antibiotics 4.8 9.5 12.7 15.6 18.2 14.4 11.7<br />

RDI < 85% 25.0 34.6 34.3 36.8 48.4 43.3 60.3<br />

9137 General Poster Session (Board #50C), Sat, 8:00 AM-12:00 PM<br />

Outpatient chemotherapy supportive care: Trial <strong>of</strong> an IT-integrated, NPdelivered<br />

system for unrelieved symptoms. Presenting Author: Kathi<br />

Mooney, University <strong>of</strong> Utah, Salt Lake City, UT<br />

Background: We tested an automated computer based remote monitoring<br />

system paired with nurse practitioner (NP) follow up using a case<br />

management system to address unrelieved symptoms. Methods: Prospectively<br />

336 patients beginning a course <strong>of</strong> chemotherapy were randomized<br />

to the Telephone Care NP (TC) intervention (n 174) or usual care (UC) (n<br />

162). All called daily reporting presence, severity, and distress (0-10 scale)<br />

for 11 common symptoms. Those in the TC intervention also received<br />

automated tailored symptom self-care messages and, based on automated<br />

alerts for unrelieved symptoms at moderate or higher levels, NP calls to<br />

further treat symptoms utilizing national guidelines. Results: There were no<br />

differences between groups on any demographics: 84% White, 56 years<br />

old, female (77%), breast (45%) or lung (17%) cancer. Average study days<br />

were 73 with 87% call completion. Prevalence <strong>of</strong> participants reporting<br />

moderate to severe symptoms were fatigue (86%), pain (80%), sleep<br />

(78%), nausea (60%), depressed mood (52%), anxious (49%), trouble<br />

thinking (48%), numbness (43%), sore mouth (38%), diarrhea (38%), and<br />

appearance concerns (35%). Mixed modeling with intention to treat was<br />

used to compare overall symptom scores by treatment condition (TC/UC)<br />

while accounting for individuals. Results indicate the TC group mean<br />

symptom score was significantly lower than UC (mean difference � .30, p<br />

� .001). Also, each symptom was significantly lower for the TC group<br />

except for diarrhea. Poisson regression showed TC had lower Severe days<br />

than UC (est. means and SE) 3.16 (0.44) vs 10.24 (1.84), p � .001; and<br />

lower Moderate days 8.91 (1.04) vs 19.06 (2.22), p � .001. TC had<br />

somewhat higher Mild days than UC 19.85 (2.81) vs 13.75 (1.85), p �<br />

.06; and more No symptom days 66.06 (3.82) vs 52.02 (4.15), p � .01.<br />

Mixed modeling was used to explore TC intervention impact following NP<br />

calls for alerts. TC reduced symptom scores compared to UC over a4day<br />

period (mean difference � 1.28, p� .001). Conclusions: Remote telephone<br />

monitoring <strong>of</strong> symptoms after chemotherapy with nurse practitioner follow<br />

up on moderate and severe symptoms results in decreased symptom<br />

severity, distress, fewer severe and moderate days and more no symptom<br />

days.<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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