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

9586 General Poster Session (Board #44H), Sun, 8:00 AM-12:00 PM
A national survey of general internists’ preferences and knowledge gaps
regarding the care of childhood cancer survivors. Presenting Author: Tara
O. Henderson, University of Chicago Pritzker School of Medicine, Chicago,
IL
Background: Although most childhood cancer survivors (CCS) report obtaining
health care in the community, primary care physicians’ views and
knowledge regarding the long-term follow-up (LTFU) care of CCS are largely
unknown. Methods: Surveys were mailed to a random sample of 1,907
general internists under age 65 years from the American Medical Association
Physician Masterfile in November 2011. A second mailing to nonresponders
is ongoing. Results: 892 (47%) physicians have responded.
Respondents have practiced a median of 10 years (range: 3-20), and see a
median of 70 patients/week (range: 40-100). 46% are in solo/group
practice, 17% in multi-specialty practice, and 14% in academic practice.
In the last five years, 53% have seen at least one CCS, 71% of whom have
never received a treatment summary. 85% prefer to care for CCS in
consultation with a cancer center based physician. A vignette of a
29-year-old female treated for Hodgkin lymphoma with mantle radiation at
age 16 was provided and participants were asked a series of questions
regarding monitoring for late effects. The percentage of responses that were
concordant with available LTFU Surveillance Guidelines were: breast
cancer, 29%; cardiac, 15%; thyroid, 77%; and all three recommendations,
only 5%. By logistic regression, greater likelihood of concordance with at
least one surveillance recommendation was associated with being female
(OR�2.0 95% CI 1.3-3.1), seeing more patients/week (OR�1.4 per SD
increase, 95% CI 1.1-1.7) and more years in practice (OR�1.3 per SD
increase, 95% CI 1.0-1.6). The two modalities felt to be most useful for
independent care of CCS by internists were access to LTFU guidelines and
receiving a patient-specific care plan from the cancer center. Conclusions:
Although the majority of internists are willing to follow CCS, they appear
unfamiliar with the available LTFU guidelines and prefer to care for
patients in collaboration with a cancer center based physician.
9588 General Poster Session (Board #45B), Sun, 8:00 AM-12:00 PM
Insurance retention in adolescent and young adult survivors of malignancies
in a vertically integrated health care system. Presenting Author: Robert
Michael Cooper, Kaiser Permenante, Los Angeles, CA
Background: Adolescents and Young Adults (AYA) with cancer are a unique
population of patients. This group is afflicted with a wide range of cancer
types. AYA patients often have delays in diagnosis due to issues related to
insurance and continuity of care and have less participation clinical trials
related to other age groups. Survivors are at risk of late effects of treatment.
A vertically integrated health care system with a comprehensive electronic
medical record provides an ideal opportunity to care for adolescent and
young adult (AYA) cancer survivors and conduct survivorship research. In
this system, patients who complete oncology care return to primary medical
care but can be tracked in a systematic fashion. Methods: We evaluated the
insurance retention of survivors of AYA malignancies by querying the
Cancer Registry and identified 13,240 known survivors of malignancies
diagnosed within the system between 1990 and 2005. We looked at the
percentage of survivors who were still cared for in our system at certain time
points after diagnosis. We then reanalyzed the group by ethnicity, disease,
and age at diagnosis. Results: The retention rate for all patients was 88% at
1 year, 64 % at 5 years, and 52% at 10 years. The retention rates were
similar regardless of ethnicity. When we looked at the influence of age at
time of diagnosis we noted that the younger the patients were at diagnosis
the lower the percentage of those retaining insurance at the 10 year time
point. We analyzed the group by the more common cancers and noted that
patients diagnosed with breast cancer had greatest retention at 10 years of
68%. Conclusions: The lengthy insurance retention of adolescent and
young adult cancer survivors makes a vertically integrated medical care
system an ideal population laboratory for cancer survivorship research in
this understudied population of cancer survivors.
Pediatric Oncology
627s
9587 General Poster Session (Board #45A), Sun, 8:00 AM-12:00 PM
Patient-perceived facilitators in the transition of survivorship care from the
pediatric to adult care setting. Presenting Author: Karim Thomas Sadak,
Children’s National Medical Center, Washington, DC
Background: Survival rates in childhood cancer continue to rise. A new
challenge has emerged in optimizing the transition of pediatric survivorship
care to similarly focused programs that are age-appropriate. The purpose of
this study is to identify components of a clinical survivorship program that
facilitate the transition of care for adult survivors of childhood cancer from
the pediatric to adult care-setting. Methods: A descriptive study of childhood
cancer survivors was conducted using a cross-sectional study design.
A questionnaire was used to identify which clinical components of a
survivorship program most influenced the decision to transition care to an
adult medical center. Primary data collection occurred through the mail.
Secondary mechanisms included an online version of the questionnaire
and in-person enrollment during survivorship clinic visits. 140 survivors
were eligible but only 129 had valid addresses and received the questionnaire.
The study endpoint was achieved when the response rate reached
80% (n�103). A descriptive review of clinical program components was
performed using a frequency analysis. Results: Of 129 invited survivors,
103 participated (80%). Mean and median age-range was 20-24 years.
There were 49 males (48%) and 54 females (52%). The most common
diagnoses were leukemia (40/103), lymphoma (20/103), and CNS tumors
(9/103). When asked if the participant was willing to transition their
survivorship care to an adult facility, 97 (95%) responded affirmatively.
The clinical components most frequently rated “Very Important” in the
decision to transition survivorship care were the acceptance of insurance
(80/103, 78%) followed by the presence of providers knowledgeable in
childhood cancer (68/103, 66%). The clinical components most frequently
rated “Very Important” or “Important” were flexible scheduling
(102/103, 99%) followed by comprehensive care being offered (101/103,
98%). Conclusions: The decision to transition survivorship care to ageappropriate
care-settings is complex and not well understood. Issues
related to insurance, clinical team composition, and scheduling appear to
be most important for young adult survivors making this decision.
9589 General Poster Session (Board #45C), Sun, 8:00 AM-12:00 PM
Psychological study of adolescent and young adult (AYA) cancer patients
and their parents throughout and beyond their cancer treatment: A pilot
study. Presenting Author: Helen Hatcher, University of Cambridge, Department
of Oncology, Cambridge, United Kingdom
Background: The cancer journey for an AYA is often complicated by
diagnostic delays, poor prognosis and negative physical and psycho-social
consequences. Distress of young patients and survivors is often overlooked
and the real incidence of psychopathology remaining hidden. We aimed to
understand the psychological impact and identify which factors most affect
the patient experience. Methods: 172 patients on the Cambridge AYA
register were invited to take part. Patients were asked to complete 2
questionnaires, SCL90 and RSQ, measuring psychological symptoms and
response styles respectively, and to take part in a semi-structured interview.
Parents were asked to complete the York Survey and be interviewed.
Results: 33 patients and 45 parents/others were recruited. Questionnaires
completed: 33 SCL90 and RSQ; 42 York Survey. Interview data from: 23
patients, 26 parents, 3 others. Patient sample: 16 male, 17 female; mean
age (recruitment) � 20.76 (16-26); age (diagnosis) � 17.26 (12-24).
Diagnoses evenly distributed across solid and haematological malignancies.
All patients had experienced significant levels of psychological
distress at some point in their cancer journey. 51% reached caseness on
the SCL90 (showed a symptom profile consistent with a high risk of a
disorder). Caseness increased with age and was correlated with higher
rumination scores. Positive influences included family, friend and peer
support, good communication and support from the AYA service and
specialist nurses. Negative influences included delayed diagnosis, poor
communication styles, anxiety about long term effects and lack of appropriate
psychological support. Conclusions: We have shown evidence of
elevated psychological symptoms in this population. Patients and their
families have prioritized clear needs; early diagnosis, high quality of
information and communication, access to psychological help at each
stage and post treatment help in gaining independence and planning for a
positive future. We should work towards meeting these needs for this
vulnerable group.
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