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

9146 General Poster Session (Board #51D), Sat, 8:00 AM-12:00 PM
Lifetime traumas and their influence on advanced cancer patients’ illness
understanding and likelihood of end-of-life discussions. Presenting Author:
Elizabeth L. Kacel, Dana-Farber Cancer Institute, Boston, MA
Background: Research on posttraumatic stress in cancer patients has
focused on patient reactions to their cancer diagnosis. Few studies have
examined the impact of lifetime traumatic events prior to diagnosis on how
advanced cancer patients understand the life-threatening nature of their
illness and how likely they are to discuss their end-of-life (EOL) wishes with
their oncology providers. Methods: The Coping with Cancer (CwC) is an
NCI-funded prospective, multi-institutional cohort study of advanced
cancer patients and their caregivers. Participants were recruited from
September 2002 to February 2008 from six comprehensive cancer centers
across the United States. Lifetime traumas were captured by the number of
events reported in response to the Structured Clinical Interview for the
DSM-IV (SCID) Lifetime Posttraumatic Stress Disorder question that
probed for “extremely upsetting” life events. Associations between patient
characteristics and number of lifetime traumas were estimated as odds
ratios using ordinal logistic regression. Associations between number of
lifetime traumatic exposures, controlling for confounding patient characteristics,
and patient Terminal Illness Acknowledgement (TIA) and reports of
EOL discussions were estimated as odds ratios using multiple logistic
regression. Results: After adjusting for race, education, and recruitment
site, the number of lifetime traumas patients reported remained significantly
associated with TIA (OR � 1.25, p � .034) and discussion of EOL
wishes (OR � 1.29, p � .013). Conclusions: The greater the number of
traumatic experiences reported by cancer patients the more likely they are
to acknowledge that they are terminally ill and discuss their end-of-life
wishes with their oncology providers. The impact of witnessing or experiencing
serious or life-threatening events in the past appears to improve
advanced cancer patients’ abilities to understand the seriousness of their
condition and increases the likelihood that they will discuss their preferences
for care at the end of life with their doctors.
TPS9148 General Poster Session (Board #51F), Sat, 8:00 AM-12:00 PM
Prospective and working memory decline as a result of impaired sleep
and/or impared blood glucose in breast cancer patients during chemotherapy
treatment. Presenting Author: Liliana Moyers-Ruiz, Bournemouth
University/ Royal Bournemouth Hospital, Bournemouth, United Kingdom
Background: Breast cancer patients might develop impaired sleep patterns
during chemotherapy, and impaired cognitive function has been associated
with sleep patterns disruption. It has been suggested that sleepiness (sleep
tendency) in cancer patients is prevalent and causes distress in the
patient’s quality of life, that and their cognitive abilities are also affected.
Furthermore, increased blood glucose levels among women undergoing
chemotherapy may contrubute to memory deficits in breast cancer patients.
It is proposed that Prospective and Working Memory are being
affected by the disturbance of these biological factors over the course of
chemotherapy. Methods: Ninety participants will be invited to take part in
the study. Thirty will be breast cancer patients receiving chemotherapy
treatment, thirty breast cancer patients receiving treatment other than
chemotheray, and thirty healthy controls. Measures of sleep and sleepiness,
will be administered at 4 testing sessions during a 9-month period,
along with a neuropsychological battery. Additionally, blood samples will
be analysed. Eight of planned 60 cancer patients have been enrolled, and
four of them have completed the second testing session. For the assessment
of sleep/wake activity, participants will be required to wear a sleeping
monitor (sensewear armband) for 7 days. Pupil dilatation to observe
sleepiness will be meassured by using a Pupillometry developed at Poole
hospital in the UK. Prospective Memory will be assessed using CAMPROMT
test to analyse if this is a more sensitive measure for mild cognitive
impairment. Discussion: Impairment on variables such as sleep, sleepiness
and glucose have not been studied within the context of Chemo-Brain on
breast cancer patients.Therefore we want to observe whether impaired
sleep and sleepiness, and impaired glucose levels are at the core of
Prospective and Working Memory decline in Chemo-Brain patients in order
to find a cause-and-effect relationship as a consequence of chemotherapy.
Patient and Survivor Care
603s
TPS9147 General Poster Session (Board #51E), Sat, 8:00 AM-12:00 PM
Using cancer patient stories to “power” communication modules. Presenting
Author: Forrest Lang, East Tennessee State University, Johnson City,
TN
Background: Caring for patients with cancer poses great challenges to
doctors’ communication skills. This project, funded by NIH-NCI, represents
an innovative collaboration between ETSU faculty in medical oncology,
family medicine, and storytelling. The team secures patients’ and
caregivers’ cooperation in recording stories of their journeys with illness.
These are the focus of a set of cancer communication modules, to be
offered as educational experiences for medical students, residents, and
oncology fellows. The modules in development address 1) breaking bad
news, 2) living through treatment, 3) transitioning from curative to
palliative care, 4) communicating with family, and 5) sensitivity to issues of
religion and spirituality. Methods: A collaborative inter-professional team
developed an interview protocol to facilitate sharing of cancer-themed
narratives. Video records are transcribed and coded using N-Vivo 8. The
rating team meets to identify video clips that speak powerfully to positive,
negative, or ambivalent aspects of cancer communication. Selected patients
are brought together into “story circles,” where additional narratives
are gathered. The module development team uses these stories to create
empathic involvement in viewers, and to sensitize them to effective and
ineffective communication strategies and challenges surrounding critical
moments in patients’ lived experience of cancer. Modules effectiveness is
tested with 1) Family Medicine and Internal Medicine residents, 2) medical
oncology fellows and 3) multi-professionals health students just completing
a communication courses. Assessment includes a pre-test and post-test
OSCE addressing a number of the challenging cancer communication
moments. Eighty-four of a projected 100 patient interviews and twelve
physician//faculty interviews have been recorded, and all have agreed to the
use of their interview materials. Representative examples of recorded
cancer stories will be presented to demonstrate their evocative and
pedagogical value. Opportunities will be discussed for further uses of these
and similar stories in collaborations between medicine and the arts and
humanities.
TPS9149^ General Poster Session (Board #51G), Sat, 8:00 AM-12:00 PM
CATCH: A randomized trial comparing tinzaparin versus warfarin for
treatment of acute venous thromboembolism (VTE) in cancer patients.
Presenting Author: Agnes Y. Lee, University of British Columbia, Vancouver,
BC, Canada
Background: VTE is a major cause of morbidity and mortality in cancer
patients. LMWHs have been shown to be superior to warfarin in one
randomized study, but adequately powered confirmatory studies have not
been conducted and warfarin continues to be widely used for treatment of
cancer-associated VTE. Methods: We are conducting an open-label, randomized
trial of tinzaparin versus warfarin in 900 patients with active cancer
and symptomatic proximal deep vein thrombosis (DVT) and/or pulmonary
embolism (PE). Tinzaparin is given at full treatment doses (175 IU/kg once
daily) for 6 months in the experimental arm and initial tinzaparin treatment
for 5-10 days followed by dose-adjusted warfarin (target INR 2.0-3.0) is
given for 6 months in the control arm. The primary composite outcome is
time to recurrent VTE event, including incidentally diagnosed VTE and fatal
PE. Baseline characteristics will be analysed for their ability to predict the
risk for recurrent VTE or bleeding. In particular, the parameters of the
Khorana scale and Wells rule will be tested for their usefulness in
predicting recurrent VTE. Predictive biomarkers will be tested including
D-dimer and Tissue Factor. Assessment of post-thrombotic syndrome
(PTS), quality of life and healthcare resource utilization will also be
performed. The trial is recruiting in � 160 sites in �25 countries in 4
continents (NCT01130025). As of Jan 2012, 135 sites were activated for
study enrolment and 228 patients have been enrolled. We anticipate
completion of enrolment in Jan 2013. The results obtained from this study
will add significantly to the knowledge on the efficacy, safety and
cost-effectiveness of LMWH to prevent recurrent VTE. Important prospective
data on the clinical significance of incidental VTE in patients with
active cancer will be generated, and analyses of risk stratification parameters
will add important information that may help to further tailor therapy.
The study of PTS, which has not previously been done in this selected
patient population, will add to the evidence that tinzaparin significantly
reduces the incidence of PTS and leg ulcers (Hull et al, Am J Med
2009;122:762-9).
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