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

600s Patient and Survivor Care
9134 General Poster Session (Board #49H), Sat, 8:00 AM-12:00 PM
Longitudinal study of hope, meaning/peace (M/P), and quality of life (QOL)
in patients (pts) with ovarian cancer (OC). Presenting Author: Lois M.
Ramondetta, University of Texas M. D. Anderson Cancer Center, Houston,
TX
Background: M/P may be the most valued end point of life. How hope, faith,
physical and psychological factors impact M/P is unknown. We evaluated
factors affecting M/P in pts with OC. Methods: OC pts at a cancer center
(CC), academic hospital (AH) and county hospital (CH for primarily
uninsured) participated. Surveys completed at initiation of chemotherapy
(CTX); completion of CTX; and 1 yr later. Surveys included FACT-O, -SP,
Herth Hope Index, Hospital Anxiety and Depression Scale (HADS), ESAS,
and Locus of Control (LOC). Results: N�115. Median age�55 yrs, married
64%, Christian 96%. CH had more AA/Hispanics pts (p�.001) and
unmarried pts (p�.001). QOL and symptoms improved for all sites over
time (p �.03); CH pts had the worst scores (p� �.001). CC pts expressed
more hope, less anxiety and depression (A/D) compared to CH and AC pts
for all time points (p�.03). CH pts had higher and increasing A/D over time
while CC pts had the least (p�.02). LOC scores differed by site (p�.01).
CH pts held strongest belief that life was controlled by chance and
“others”; CC pts had the least. There was no association between site/time
for belief of internal control over one’s life. CH pts consistently had the
lowest M/P scores (p�004). Adjusting for site, disease status and time,
higher M/P associated with higher hope, better QOL, symptoms and faith
(p� �.0001). Lower M/P associated with increased A/D (p�.003) and
symptoms (p�.0001). Poorer M/P over time correlated with belief that life
was controlled by chance (p�.01) and �powerful others�(p�.02). Level of
M/P did not correlate with belief of internal control over one’s life.
Conclusions: M/P did not change over time. CC pts had highest M/P. Higher
M/P associated with higher hope and faith, better QOL, less symptoms and
A/D. Lower M/P associated with sense that life is controlled by chance and
powerful others. Data show medically underserved pts have poorer QOL,
more symptoms and A/D and may believe the future is determined by
luck/chance and by “others”. Triaging for spiritual crisis may be important
in these pts. Interventions to decrease A/D and symptoms may improve pts’
sense of M/P over the cancer journey.
9136 General Poster Session (Board #50B), Sat, 8:00 AM-12:00 PM
Associations between receipt of a treatment summary, emotional concerns,
and patterns of care among post-treatment cancer survivors. Presenting
Author: Ruth Rechis, LIVESTRONG, Austin, TX
Background: Treatment summaries (TS), a critical component of survivorship
care plans, were identified as a tool to improve long-term outcomes for
the 12 million cancer survivors alive in the US. Methods: In 2010, the
Lance Armstrong Foundation fielded the LIVESTRONG Survey for People
Affected by Cancer. Respondents were recruited through several channels
including partnerships with national organizations such as ASCO. Over a 9
month period, more than people completed the survey, including 3,682
post-treatment cancer survivors (PTCS). The survey addressed posttreatment
concerns including receipt of TS. Full survey results were
presented at the 2011 ASCO Conference. Results: Receipt of TS data was
available for 3042 PTCS: average age (50); female (65%); average time
since diagnosis (6 years); received a TS (34%). PTCS who received TS
reported that they were: Closer to time since diagnosis or since treatment
ended (p�0.01); more likely to have received chemotherapy (p�0.01);
more often receiving the majority of their health care from a medical
oncologist (p�0.05); experiencing significantly fewer (p�0.05) posttreatment
emotional concerns (including emotional distress; fears of
recurrence; concerns about family risk; and appearance concerns) and
were more likely to have received care; significantly less likely to say that
they had “learned to live with” their concerns (p�0.05) – the most
common reason among participants for not receiving care. Finally, receipt
of a TS was related to higher information efficacy (p�0.01; which appeared
to mediate the relationship between receipt of a TS and fewer emotional
concerns). PTCS who received a TS more often reported that their needs
were met including information received about possible late-effects; care
they got during treatment; and care they received after treatment.
Conclusions: These results support the provision of TS to PTCS. Receipt of
TS was associated with a variety of positive outcomes; however, only about
one-third of PTCS received one. Future studies focused on patient
perspectives on care planning tools, such as treatment summaries and care
plans, can help to improve optimal survivorship care delivery.
9135 General Poster Session (Board #50A), Sat, 8:00 AM-12:00 PM
Prospective cohort study of chemotherapy-associated toxicity and supportive
care in oncology practice. Presenting Author: Eva Culakova, Duke
University, Durham, NC
Background: Neutropenic complications remain important dose-limiting
toxicities of cancer chemotherapy associated with considerable morbidity,
mortality and cost. The risk of the initial neutropenic event is greatest in the
first cycle when most patients are receiving full dose chemotherapy.
Methods: A prospective cohort study of adult patients with solid tumors or
lymphoma receiving a new chemotherapy regimen was conducted at 115
U.S. practice sites between 2002 and 2006. Chemotherapy-associated
toxicities were captured in up to 4 cycles including severe neutropenia
(SN), febrile neutropenia (FN), and infection. Documented interventions
included colony-stimulating factor (CSF) and antibiotics use and reductions
in chemotherapy relative dose intensity (RDI). Results: Results are
available on 3,638 patients starting chemotherapy of which 3,301, 2,937,
and 2,199 went on to cycles 2, 3, and 4, respectively. The majority of
neutropenic and infection events occurred in cycle 1. A significant inverse
relationship was observed between subsequent reductions in neutropenic
and infectious events and efforts to reduce these complications (Table).
Most patients with stage 4 solid tumors underwent reductions in chemotherapy
RDI. Patients with lymphoma and stage 1-3 solid tumors were less
likely to undergo dose reductions with half or more receiving prophylactic
CSFs during treatment. Approximately 15% of patients also received
prophylactic antibiotics. Conclusions: While the risk of neutropenic complications
remains greatest during the initial cycle of chemotherapy, clinician
efforts to reduce the risk of these events vary with cancer type and stage.
Reduced dose intensity is evident in two-thirds of patients with advanced
solid tumors whereas the CSFs are employed in half to two-thirds of
patients with early stage solid tumors or lymphoma.
Percent of patients (%)
Cycle-specific events Cumulative events
Solid tumor Solid tumor
Measure
1 2 3 4 Lymphoma stage 1-3 stage 4
FN 6.4 3.8 2.9 0.8 13.7 11.9 7.8
SN or FN 20.0 14.4 13.5 14.3 37.3 33.4 20.6
Infection 12.6 9.4 8.6 1.7 27.5 23.6 21.1
Proph CSF 21.2 38.9 47.9 53.7 63.5 49.5 35.2
Proph antibiotics 4.8 9.5 12.7 15.6 18.2 14.4 11.7
RDI < 85% 25.0 34.6 34.3 36.8 48.4 43.3 60.3
9137 General Poster Session (Board #50C), Sat, 8:00 AM-12:00 PM
Outpatient chemotherapy supportive care: Trial of an IT-integrated, NPdelivered
system for unrelieved symptoms. Presenting Author: Kathi
Mooney, University of Utah, Salt Lake City, UT
Background: We tested an automated computer based remote monitoring
system paired with nurse practitioner (NP) follow up using a case
management system to address unrelieved symptoms. Methods: Prospectively
336 patients beginning a course of chemotherapy were randomized
to the Telephone Care NP (TC) intervention (n 174) or usual care (UC) (n
162). All called daily reporting presence, severity, and distress (0-10 scale)
for 11 common symptoms. Those in the TC intervention also received
automated tailored symptom self-care messages and, based on automated
alerts for unrelieved symptoms at moderate or higher levels, NP calls to
further treat symptoms utilizing national guidelines. Results: There were no
differences between groups on any demographics: 84% White, 56 years
old, female (77%), breast (45%) or lung (17%) cancer. Average study days
were 73 with 87% call completion. Prevalence of participants reporting
moderate to severe symptoms were fatigue (86%), pain (80%), sleep
(78%), nausea (60%), depressed mood (52%), anxious (49%), trouble
thinking (48%), numbness (43%), sore mouth (38%), diarrhea (38%), and
appearance concerns (35%). Mixed modeling with intention to treat was
used to compare overall symptom scores by treatment condition (TC/UC)
while accounting for individuals. Results indicate the TC group mean
symptom score was significantly lower than UC (mean difference � .30, p
� .001). Also, each symptom was significantly lower for the TC group
except for diarrhea. Poisson regression showed TC had lower Severe days
than UC (est. means and SE) 3.16 (0.44) vs 10.24 (1.84), p � .001; and
lower Moderate days 8.91 (1.04) vs 19.06 (2.22), p � .001. TC had
somewhat higher Mild days than UC 19.85 (2.81) vs 13.75 (1.85), p �
.06; and more No symptom days 66.06 (3.82) vs 52.02 (4.15), p � .01.
Mixed modeling was used to explore TC intervention impact following NP
calls for alerts. TC reduced symptom scores compared to UC over a4day
period (mean difference � 1.28, p� .001). Conclusions: Remote telephone
monitoring of symptoms after chemotherapy with nurse practitioner follow
up on moderate and severe symptoms results in decreased symptom
severity, distress, fewer severe and moderate days and more no symptom
days.
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