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A. Van Dam



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    O19 - Support and Palliation I (ID 138)

    • Event: WCLC 2013
    • Type: Oral Abstract Session
    • Track: Nurses
    • Presentations: 1
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      O19.07 - Resource utilization in the last three months of life by lung cancer patients in the Hamilton-Niagara-Haldimand-Brant Local Health Integration Network (LHIN) (ID 1669)

      11:35 - 11:45  |  Author(s): A. Van Dam

      • Abstract
      • Presentation
      • Slides

      Background
      Data from the Ontario Cancer System Quality Index demonstrate a high use of Emergency Department (ED) services by lung cancer patients in the last three months of life. There is a need to better understand the resource utilization of lung cancer patients during this time period.

      Methods
      A retrospective cohort study was undertaken to evaluate resource utilization in the last three months of life for new patients with lung cancer seen at the Juravinski and Walker Family Cancer Centres between January and June 2011and deceased prior to July 2012. Data abstracted from patient records included demographics, staging, treatment, referral to palliative care, use of community services, visits to the cancer centre and family doctor, visits to the emergency department and hospitalizations in the last three months of life. The primary outcome was the proportion of patients using the ED in the last three months of life. Secondary outcomes include the proportion of patients hospitalized, place of death, and the use of community and palliative care services.

      Results
      There were 323 new patients seen during the six month period and 162 were deceased at the time of data cut-off. There were 86 men (53%) and 76 women (47%), with a median age at diagnosis was 68.9 years (range 38-90). The majority were married (66%), but 20% were living alone. Twenty percent of patients had SCLC, 73% NSCLC and 7% did not have tissue diagnosis. Most patients (n=141, 87%) were treated with palliative intent from the outset. Chemotherapy was administered to 63 patients (39%) with 11 (7%) receiving chemotherapy within the last 2 weeks of life. A greater proportion of patients received radiation therapy (n=111, 69% [10% radical, 90% palliative]). The median overall survival was 4.1 months (95%CI 3.4-4.8m). The majority of patients (n=132, 82%) were referred to community care services (CCAC) and most of these received community palliative services (n=113, 70%). The median time from CCAC referral to death was 2.5 months (0.3 – 31 months). There was documentation about a change in goal from active treatment to supportive care in 38% of patients and documentation of end of life discussion in 66% of patients. Place of death was: hospital (51%), home (21%), hospice/palliative care institution (20%), unknown (8%). During the last three months of life 93% visited the cancer centre (median visits 2, range 0-10) and 67% made calls to the cancer centre (median 1, range 0-19). Visits to the ED were made by 118 patients (73%, median visits 1, range 1-9) and 36 patients were hospitalized (22%, median 1, range 1-5). Patients referred to CCAC were less likely to visit the ED (72% v 83%, p=0.2).

      Conclusion
      Lung cancer patients use considerable range of services during the last three months of life. Use of acute care services such as the ED and hospitalizations are common. CCAC referral has a small impact on the use of acute care services.

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    P2.10 - Poster Session 2 - Chemotherapy (ID 207)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Medical Oncology
    • Presentations: 1
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      P2.10-029 - Educating community health professionals about lung cancer: A pilot evaluation of a web-based educational tool (ID 1663)

      09:30 - 09:30  |  Author(s): A. Van Dam

      • Abstract

      Background
      Previous research demonstrated significant delays from the onset of lung cancer symptoms to diagnosis and commencement of treatment. This has potential to influence the outcome of treatment. However, the diagnosis of lung cancer is complicated by considerable overlap between lung cancer symptoms and those of other common respiratory illnesses such as COPD. We sought to evaluate the impact of education of community health professionals about lung cancer on perception of knowledge.

      Methods
      A web-based educational program was developed by expert panel, to disseminate information about lung cancer. Interactive small group workshops were organized within local communities targeting primary care physicians and primary care nurses involved in the initial evaluation of patients with suspected lung cancer. The web-based application covered lung cancer statistics, presenting symptoms, frequently asked questions, links to the new diagnostic assessment program, and key advances in treatment. Invitations were sent to all family physicians in the Hamilton and Haldimand regions of Ontario to attend a pilot session. Pre and post questionnaires were administered to assess the utility of the educational program. Follow up questionnaires were mailed out after six months to evaluate the value of the educational program.

      Results
      Education sessions were conducted in six family practice offices and one occupational health practice, involving 67 health professionals. There were 46 pre and 40 post intervention questionnaires completed (24 physicians, 10 nurses and 12 other). Responses were similar between city (n=20) and rural-based (n=26) health professionals. All respondents felt the educational session was beneficial to attend. Over 85% of respondents agreed the information was clear and easy to understand, of sufficient detail and relevant to practice. Most respondents (88%) felt they would use the web-based tool personally and 90% felt they would use it for patient education. Following the educational intervention, there was some improvement in respondents’ assessment of their knowledge about lung cancer: understanding and background knowledge about lung cancer (79% v 90%); common presenting symptoms of lung cancer (81% v 92%); understand steps needed to diagnose lung cancer (79% v 80%), standard approach to treatment of lung cancer (52% v 95%); recent advances in treatment of lung cancer (19% v 92%). Six month follow up questionnaires were sent to 45 individuals, with 31 replies. Only 4 respondents (13%) had used the web-based tool. The most commonly used section was on the treatment of lung cancer. The majority of respondents (52%) had not seen a lung cancer patient during this time period. Other reasons included for not using the program included: no need (7%), insufficient time (15%), and did not think about it (11%). Respondents’ assessment of their lung cancer knowledge was lower at six months (range 45%-80%).

      Conclusion
      have shown that it is feasible to implement a web-based lung cancer interventional program in family practice. This may improve short term knowledge about lung cancer, but this does not appear sustained at six months. One limitation to the utility of this program is the relative infrequency of lung cancer patients seen by individual family physicians.