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J. Ingham
Moderator of
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O19 - Support and Palliation I (ID 138)
- Event: WCLC 2013
- Type: Oral Abstract Session
- Track: Nurses
- Presentations: 8
- Moderators:Y. Chen, J. Ingham
- Coordinates: 10/29/2013, 10:30 - 12:00, Bayside 104, Level 1
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O19.01 - Health Informatics and Oncology in Global Health: A Pilot Program in Affordable Network technologies in Haiti (ID 1478)
10:30 - 10:40 | Author(s): P.R. Theodore, A. Sawyer, J. Donovan, R. D'Amuse, C. Yeh
- Abstract
- Presentation
Background
A projected 75% increase in cancer deaths are expected in Low and Middle Income Countries (LMIC) by 2020. As successful battles against infectious disease and malnutrition deaths are waged, the demands on poor healthcare systems to create affordable oncology infrastructure will become ever more acute. Effective and efficient collaborative technologies that permit presentation of cases from resource limited environments to healthcare professionals in the developed world can aid in decision making, treatment planning and education. In this trial a novel clinical platform was launched in Haiti and we present a case of a chest wall malignancy demonstrating the platform's capacity for collaboration and clinical management between a resource limited community hospital in Haiti and Academic Medical Centers in the United States.Methods
An Extensible Markup Language (XML) based system was built according to specifications of clinicians in the Thoracic Oncology Service of University of California San Francisco Medical Center. In a community hospital in Saint Marc, Haiti 30 cases involving a variety of clinical conditions across adult and pediatric oncology and traumatic disease were presented to Academic Medical Center volunteer physicians in the United States on a web-based asynchronous clinical collaboration system. The infrastructure required transfer over a wireless network in Haiti followed by secure transmission via internet to the dedicated servers in the United States.Results
Case 1: A 32 year old Haitian Male presented to the Hopital Saint Nicholas in Saint Marc, Haiti with posterior chest and shoulder pain and a chest wall mass extending to the scapula. X-rays revealed a destructive lesion of the chest wall without frank mass within the pulmonary parenchyma. An open biopsy was performed and the specimen transferred for pathologic evaluation at The University of California San Francisco. Clinicians from 3 medical centers in the US came to a consensus opinion regarding diagnosis (unicentric plasmacytoma of chest wall) and treatment strategy within 3 days. Digital images of Immunohistochemical staining, X-rays uploaded to the collaboration platform via a smartphone photo app and literature reviews of the case were transmitted to Haitian physicians including a treatment plan recommendations . 29 additional patients have been offered evaluation in a web based environment and will be discussed.Conclusion
Oncology cases in the developing world are increasingly prominent in light of advances in combating infectious disease and poverty related malnutrition. However resource limited environments may not have access to clinical decision tools, diagnostic measures or treatments commonplace in fully developed countries. Inexpensive collaborative technologic tools as demonstrated in this pilot can serve as a bridge between developed and developing countries in combination with the will to improve health among the planet's poorest communitiesOnly Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.
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O19.02 - Developing Guidance For The Supportive And Palliative Care Of Lung Cancer And Mesothelioma Patients And Their Carers (ID 84)
10:40 - 10:50 | Author(s): A.D.M. Richardson, J. Draffan, J. White
- Abstract
- Presentation
Background
Lung cancer remains the United Kingdom's commonest cause of cancer death and accounts for 1 in 14 of UK deaths from cancers. Approximately 41,428 new cases of lung cancer and 2500 new cases of mesothelioma are diagnosed in the UK (CRUK : Cancer Research UK 2009.) Evidence shows eighty per cent of people will present with advanced disease and the majority of these will die within a year of diagnosis (CRUK 2009.) There is a large amount of evidence in existence to support end of life care but this is very generic in nature. Consensus opinion from the National Lung Cancer Forum for Nurses recognised the need for specialist guidance for lung cancer and mesothelioma patients to enhance their end of life experience and to inform health care professionals who are caring for this group of patients. The focus of the project was to develop guidance driven by evidence from patients and carers, to focus on issues highlighted by them that were important. Previous guidance produced had not had this direct focus.Methods
This guidance has been developed over an eighteen month period by a dedicated working party with expertise in caring for lung cancer and mesothelioma patients and carers and incorporating current evidence and guidance which was reviewed extensively. The document provides detailed supportive and palliative care specialist interventions to assist any health care professional who is caring for a patient with advanced lung cancer or mesothelioma. The guidance is focused around nine key elements that were identified in work carried out by the Health Experience Research Group at the University of Oxford. Cancer patients identified nine key areas of their care that were important to them or that they found to be lacking. Holistic approach to care. Getting the bad news. Care co ordination. Responsiveness and ease of access to benefits and support. Pain control and symptom management. Staff attitudes and empathy. End of life choice and the actual experience. Carer focus. Each of these nine key elements are addressed within the guidance. Recommendations are made based on evidence and specialist experience. Good practice examples are included collected from a wide range of lung cancer services across the United Kingdom to assist users to develop their own practice.Results
The guidance was completed and published in Novmber 2012. The guidance provides a usable document with evidence and practice examples to assist health care professonals to improve supportive and palliative care within their area. The document is being diseminated locally by specialist lung cancer nurses and nationally via the National Lung Cancer Forum for Nurses.Conclusion
Although recently published and to date has not been formally evaluated, this guidance has been well received by health care professionals and organisations associated with the care of lung cancer and mesothelioma patients. References 1. Cancer Research UK (2009) : Incidences of Lung Cancer (online) Cancer Research UK. Available from 2. Health Experience Research Group (HERG) University of Oxford, GC Associates, Unpublished.Only Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.
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O19.03 - Perceptions and attitudes to early integration of palliative care for patients with incurable lung cancer (ID 2588)
10:50 - 11:00 | Author(s): L. Mileshkin, J. Philip, K. Doan, O. Spruyt, M. Conron, D. Gunawardana, S. Carvosso, D. Saward, B. Le
- Abstract
- Presentation
Background
Lung cancer is the leading cause of death from cancer in Australia with the majority of patients diagnosed with late stage incurable disease. Although there is evidence of patient benefit from early involvement with specialist palliative care, this may not translate into clinical practice. The aim of this study was to explore clinicians’ perceptions and attitudes to Palliative Care referral.Methods
A modified validated self-report palliative care referral questionnaire (Johnson, 2008) was given to doctors and nurses working in the multi-disciplinary lung cancer teams at three teaching hospitals in metropolitan Melbourne. Participants were asked whether listed items had contributed to referral (9 triggers) or non referral (15 barriers) of their patients. Level of agreement with 22 attitudinal and perception items explored clinicians’ views about palliative care.Results
55 questionnaires were distributed and 42 completed (76% response rate). Respondents had a median of 6 years (interquartile range 3-12) of experience practicing in their specialty. One-third (14/42) were doctors working in Medical Oncology, 26% (11/42) in Respiratory Medicine, 19% (8/42) in Radiation Oncology, and 12%, (5/42) in Surgical Oncology, plus two oncology nurses and one physician trainee.93% of respondents agreed that early referral to Palliative Care is beneficial to patients and 95% agreed that Palliative Care can benefit patients receiving active treatment. The majority (69%) of clinicians believe that their relationship with the patient continues when she/he elects to have specialist palliative care. 71% indicated that it is not difficult to refer a patient they have cared for a long time and have a close relationship with. Almost two-thirds (64%) disagreed that when they first bring up palliative care patients give up hope. However, only 60% of respondents agreed that all advanced cancer patients should be referred to Palliative Care. The most frequently cited reasons for referral were for physical symptoms. The majority reported that Palliative Care is either very important or important for patients with psycho-social issues or foreseeable future psycho-social issues, yet only half of respondents agreed that psycho-social issues would trigger a referral to Palliative Care. When asked for the main reasons for not referring to Palliative Care, 60% agreed they do not refer when the patient has no symptoms and 60% also agreed they do not refer if they can manage the patients’ symptoms themselves. However, only 38% of clinicians reported they were well trained to take care of the symptoms of advanced cancer patients. Issues related to patients not understanding or accepting their prognosis were cited as barriers to referral by more than a third of clinicians.Conclusion
Clinicians involved in the care of patients with incurable lung cancer have positive perceptions and attitudes to Palliative Care but this may not translate into routine referral of all patients with incurable lung cancer. In order to make referral routine, we need education around the perception that only patients with unmanageable symptoms benefit from referral to Palliative Care. Furthermore, additional training of oncologists about symptom management appears desirable since a significant proportion reported a deficiency in this area.Only Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.
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O19.04 - DISCUSSANT (ID 4008)
11:00 - 11:15 | Author(s): J. Phillips
- Abstract
- Presentation
Abstract not provided
Only Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.
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O19.05 - Guidance for the Assessment of Patients following Palliative Radiotherapy for Lung Cancer (ID 112)
11:15 - 11:25 | Author(s): J. White, D. Borthwick, V. Beattie
- Abstract
- Presentation
Background
Palliative radiotherapy to the thorax is very effective at managing symptoms and improving quality of life but can also have significant toxicity. Dosing decisions are a balance between potential benefit and toxicity in patients whose prognosis and performance status is poor and who are likely to have multiple co-morbidities and complex causation of symptoms. Observations made by the members of the Uinted Kingdom National Lung Cancer Forum for Nurses (NLCFN) raised concerns that this group of patients may not be receiving optimal intervention and support following palliative radiotherapy. The NLCFN has therefore produced Guidance for the Assessment of Patients following Palliative Radiotherapy for Lung Cancer to aid Lung Cancer Nurse Specialists (LCNS) in the assessment and intervention of patients undergoing low dose palliative radiotherapy for symptoms related to lung cancer and side effects from treatment.Methods
A NLCFN working group was created to analyse the observation of sub-optimal care following palliative radiotherapy. A literature review was undertaken to identify current best evidence and practice. A survey was undertaken to question LCNS, Clinical Oncologists, as well as Radiographers who could provide whether there was a need for such a guideline. 53 responses were received. Following analysis of the survey and discussion within the working group the Guidance for the Assessment of Patients following Palliative Radiotherapy for Lung Cancer was produced. The guidance aims to aid LCNS in the assessment and intervention of patients undergoing low dose palliative radiotherapy for symptoms related to lung cancer and side effects from treatment. Table 1 Figure 1Figure 2Figure 3Results
Following the literature review, although there was significant evidence of toxicity profiles and effects of treatment, there were no examples of how to address the support needs of patients following palliative radiotherapy to the thorax. Of the 53 responses, 75% said that there was a need for the service, 54% were not aware of current practice in radiotherapy follow up support, with 55 % stating that a review should take place between 1 and 2 weeks after treatment. The working group produced the guideline following discussion in relation to these outcomes.Conclusion
The Guidance for the Assessment of Patients following Palliative Radiotherapy for Lung Cancer aims to guide LCNS and the treating teams in the assessment and intervention of patients undergoing low dose palliative radiotherapy for symptoms related to lung cancer. The guideline contains flow charts with recommended interventions together with documentation proforma and Common Toxicity Criteria. In the UK patients are treated in Cancer Centres and often repatriated to secondary care for review and follow-up. The formal assessments provided in the Guidance can be implemented either in the clinic, telephone or home visit. The guideline could be adapted for use in other health care systems other than the UK and can be found at http://www.nlcfn.org.uk/NLCFN-guidelines.htmOnly Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.
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O19.06 - A retrospective study into the impact palliative care intervention had on place of death for patients diagnosed with non-small cell lung cancer between 2006 and 2011 in the Illawarra Shoalhaven Local Health District (ID 328)
11:25 - 11:35 | Author(s): J.A. Rose
- Abstract
- Presentation
Background
Between 01/01/2006 and 31/12/2011, 1070 cases of non-small cell lung cancer (NSCLC) were registered in the Illawarra Shoalhaven Local Health District (ISLHD) Clinical Cancer Registry (ClinCR); having been diagnosed and/or received a cancer directed treatment (including end-of-life palliative care) in an ISLHD public facility. A retrospective study was undertaken to determine the impact palliative care involvement had on the place of death for patients in this cohort who were known to be deceased.Methods
A retrospective study was undertaken using data recorded in ClinCR. Data items include date of death, name of public facility where death occurred, palliative care status and date of referral to palliative care. Patients who did not die in public hospital had the place of death recorded in a free text box in ClinCR if it was documented in one of ISLHD’s electronic medical records: PowerChart, iPM, CHIME or MOSAIQ.Results
Of the 1070 cases, 936 (87.5%) patients were known to be deceased, with 93% (872n) of those patients dying locally: palliative care facility 52% (454n); hospital 27.5% (240n); home 14.5% (127) and RACF 6% (51n). The remaining 7% died out of the Area (12n) or had “unknown” recorded for place of death (52n). 87% of those known to be deceased were referred to palliative care. Of the deceased patients not referred to palliative care, 45% died in an acute hospital, compared to 14% of those who were referred to palliative care. Home was the second most frequent place of death (15% 121n) for patients referred to palliative care.Conclusion
This study shows the impact palliative care involvement had on the place of death for non-small cell lung cancer patients in ISLHD. Although more than 50% died in a dedicated palliative care ward/facility, the data shows that patients with palliative care intervention are more likely to die in their home, and less likely to die in an Acute Hospital. Patients with respiratory cancers may require hospital admissions due to local complications which may not occur in other cancers; making a comparison between this and another tumour stream a worthwhile exercise.Only Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.
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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): P.M. Ellis, S. Schiff, A. Van Dam, C. McMillan, M. Slaven, S. Hapke, L. Martelli-Reid, P. Hughes, J.R. Goffin, J. Sussman
- Abstract
- Presentation
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.Only Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.
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O19.08 - DISCUSSANT (ID 4009)
11:45 - 12:00 | Author(s): R. Chye
- Abstract
- Presentation
Abstract not provided
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